Jordan R Wilson, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

122541 Issued in MA

Practice address

1340 Boylston St
Boston, MA 02215-4302

Phone

(617) 247-7555

Fax

(617) 262-0872

NPI assigned

Aug 26, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Jordan Nejaime Former name

Medicare fee-for-service enrollment

Enrolled in MA

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, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fenway Community Health Center, IncGroup PAC ID 0941299655, 79 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.

• Fenway Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Boston, MA
  • NPI 1003804725
  Medicare reassignment Care Compare group NPD
• Fenway Community Health Center, Inc

  • Pharmacist
  • Boston, MA
  • NPI 1275647505
  NPD
• Fenway Community Health Center, Inc

  • Internal Medicine Physician
  • Cambridge, MA
  • NPI 1689318503
  NPD (past)

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

{
    "created_epoch": "1566777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733961600000",
    "number": "1346898111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1340 BOYLSTON ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022154302",
            "telephone_number": "617-247-7555",
            "fax_number": "617-262-0872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1340 BOYLSTON ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022154302",
            "telephone_number": "617-247-7555",
            "fax_number": "617-262-0872"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4909 E McDowell Rd",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850084227",
            "country_code": "US",
            "telephone_number": "602-685-6000",
            "fax_number": "602-275-1355",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JORDAN",
        "middle_name": "R",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-26",
        "last_updated": "2024-12-12",
        "certification_date": "2024-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "122541",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AZ",
            "license": "LCSW-18006",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JORDAN",
            "last_name": "NEJAIME",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jennifer Lynn Wilson, MD
• Jennifer M. Wilson, CRNA
• Jesse H Wilson, NURSE PRACTITIONER
• Jessica Wilson, PT, DPT
• Jordan A. Wilson, LMHC
• Joshua Wilson
• Julia Grace Wilson, DNP
• Justin Wilson
• Kathryn Clare Wilson, MS, RD, LDN, CNSC
• Kayla Tenniel Wilson I

• Clinical Social Worker in Boston, MA
• Providers in Boston, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2024; 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.