Jennifer Wiley Campbell, LMSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

111415 Issued in NY

Practice address

6801 Fresh Pond Rd Apt 5
Ridgewood, NY 11385-5233

Phone

(713) 248-0753

NPI assigned

Mar 25, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Service Program for Older People, Inc

  • Geriatric Psychiatry Physician
  • New York, NY
  • NPI 1740211143

  NY

  Medicare reassignment Care Compare group NPD (past)

Specialty

Clinical Social Worker

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Service Program for Older People Inc 15 clinicians

Practice addresses (Care Compare)

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

{
    "created_epoch": "1648166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648166400000",
    "number": "1366192098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6801 FRESH POND RD APT 5",
            "city": "RIDGEWOOD",
            "state": "NY",
            "postal_code": "113855233",
            "telephone_number": "713-248-0753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6801 FRESH POND RD APT 5",
            "city": "RIDGEWOOD",
            "state": "NY",
            "postal_code": "113855233",
            "telephone_number": "713-248-0753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "JENNIFER",
        "middle_name": "WILEY",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-25",
        "last_updated": "2022-03-25",
        "certification_date": "2022-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "111415",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Doru Ion Buza, M.D.
• Fatima Andrea Cabrera
• Liora Cahana, LMSW
• Esther Calberto, M.S. OTR/L BIL TSHH
• Gina Campagna, M.S. CCC-SLP
• Diana P Campos, D.D.S.
• Thomas Cannone
• Kim Capena
• Caponegro Urological Associates MDPC
• Jeanann Cappellino-Ferra, COTA

• All providers in Ridgewood, NY
• Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2022; 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.