Jennifer Theo Reardon, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

081336 Issued in NY

Practice address

191 Broadway
Amityville, NY 11701-2790

Phone

(631) 264-0058

Fax

(631) 264-0056

NPI assigned

Feb 8, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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

Specialty

Clinical Social Worker

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Family Service League IncGroup PAC ID 4284524448, 47 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Family Service League, Inc.

  • Community/Behavioral Health Agency
  • Huntington, NY
  • NPI 1528093242
  Medicare reassignment Care Compare group NPD
• South Bay Counseling, LCSW PC

  • Clinical Social Worker
  • Amityville, NY
  • NPI 1992112510
  NPD (past)

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446076800000",
    "number": "1346380276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 LAWRENCE AVE",
            "city": "HOLBROOK",
            "state": "NY",
            "postal_code": "117411019",
            "telephone_number": "631-741-8896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "191 BROADWAY",
            "city": "AMITYVILLE",
            "state": "NY",
            "postal_code": "117012790",
            "telephone_number": "631-264-0058",
            "fax_number": "631-264-0056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REARDON",
        "first_name": "JENNIFER",
        "middle_name": "THEO",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-08",
        "last_updated": "2015-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "081336",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "072012",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Junaid Rajani, DDS, MS
• Amanda Rae Ramalhete, MS, RDN, CDN
• Raman Kumar MD PLLC
• Caitlin Randazzo, NP
• Randi Z. Therapy, Consulting, LCSW, P.C.
• Youn Redondo, PA-C
• Robbi Lynn Reed, OTD, OTR/L
• Nigar Rehman, MD
• Karen Marie Remson, N.P
• Renewed Life Mental Health Counseling

• Clinical Social Worker in Amityville, NY
• Providers in Amityville, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.