Individual provider Active NPI

Jessica Stucker, LICSW, MLADC

  • Clinical Social Worker
  • Portsmouth, NH
National Provider Identifier
1316249691
Registry record updated Oct 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
1947 Issued in NH
Practice address
1 Middle St Ste 223
Portsmouth, NH 03801-4391
Phone
(857) 302-0313
Fax
(603) 766-0009
NPI assigned
Nov 19, 2010
Last updated
Oct 18, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 1017 NH
Clinical Social Worker 1041C0700X 1947 NH Primary

Addresses

Primary practice location

1 Middle St Ste 223
Portsmouth, NH 03801-4391

Mailing address

1 Middle St Ste 223
Portsmouth, NH 03801-4391
Phone (857) 302-0313

Other practice location 1

272 County Farm Rd
Dover, NH 03820-6003
Phone (603) 516-8160 ext. 8179

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190610001926 NH Practitioner - Clinical Social Worker 4789969643 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2014
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1 Middle St
Suite 223
Portsmouth, NH 03801-4391
Phone (857) 302-0313

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1017NHMDMidwife
1947NHMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Silver Linings Counseling, LLC Clinical CurrentSince Sep 1, 2020 Accepting new patients
Salem Psychological Associates, PA CurrentSince Apr 29, 2019 Accepting new patients
Behavioral Health and Developmental Services of Strafford County, Inc Past Accepting new patients

Locations

1 Middle St
Ste 223
Portsmouth, NH 03801
Phone (603) 294-1428

87 Stiles Rd
Ste 106
Salem, NH 03079
Phone (603) 893-7700

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1290124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602979200000",
    "number": "1316249691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MIDDLE ST STE 223",
            "city": "PORTSMOUTH",
            "state": "NH",
            "postal_code": "038014391",
            "telephone_number": "857-302-0313",
            "fax_number": "603-766-0009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MIDDLE ST STE 223",
            "city": "PORTSMOUTH",
            "state": "NH",
            "postal_code": "038014391",
            "telephone_number": "857-302-0313",
            "fax_number": "603-766-0009"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "272 County Farm Rd",
            "address_purpose": "LOCATION",
            "city": "Dover",
            "state": "NH",
            "postal_code": "038206003",
            "country_code": "US",
            "telephone_number": "603-516-8160 x8179",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STUCKER",
        "first_name": "JESSICA",
        "name_prefix": "Mrs.",
        "credential": "LICSW, MLADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-11-19",
        "last_updated": "2020-10-18",
        "certification_date": "2020-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NH",
            "license": "1017",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NH",
            "license": "1947",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portsmouth, NH

Sources for this page

Verify at the official NPI Registry.