Jamie Declercq, LISW-SUPV

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I0031486-SUPV Issued in OH

Practice address

924 N Cable Rd
Lima, OH 45805-1704

Phone

(419) 969-3125

NPI assigned

May 11, 2011

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

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

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.

• Encompass Care, Inc.

  • Community/Behavioral Health Agency
  • Lima, OH
  • NPI 1912412768
  Medicare reassignment NPD
• Lighthouse Behavioral Health Solutions, LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Columbus, OH
  • NPI 1629560230
  Medicare reassignment NPD
• Encompass Care, Inc.

  • Community/Behavioral Health Agency
  • Fairview, PA
  • NPI 1508537721
  NPD

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

{
    "created_epoch": "1305072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710633600000",
    "number": "1366734279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 SHAWNEE RD",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458053583",
            "telephone_number": "419-999-3607",
            "fax_number": "419-999-6284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "924 N CABLE RD",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458051704",
            "telephone_number": "419-969-3125"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "399 E Main St",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432155384",
            "country_code": "US",
            "telephone_number": "614-355-8550",
            "fax_number": "614-355-8593",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2535 Fort Amanda Rd",
            "address_purpose": "LOCATION",
            "city": "Lima",
            "state": "OH",
            "postal_code": "45804",
            "country_code": "US",
            "telephone_number": "419-999-2055",
            "fax_number": "419-999-2058",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DECLERCQ",
        "first_name": "JAMIE",
        "credential": "LISW-SUPV",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-11",
        "last_updated": "2024-03-17",
        "certification_date": "2024-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I0031486-SUPV",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0251480",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Zane Waji M Dean, MD
• Susan Debell
• Deborah Champion DDS Inc
• Raymond Enrique Decanio, M.D.
• Rogelio R Decanio, MD
• Angela Dene Deeds
• Jade Lindsey Deerhake, CPRS
• Mary Deeter, CRNA
• Matthew Defalco
• Cameran C Deffenbaugh

• Clinical Social Worker in Lima, OH
• Providers in Lima, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.