Diane S Jerdan, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

R0507620 Issued in NY

Practice address

122 West Court St
Ithaca, NY 14850

Phone

(607) 275-3675

NPI assigned

Nov 1, 2006

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

Not listed in the public Medicare enrollment file

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.

• Court St. Chiropractic of Ithaca, P.C.

  • Chiropractor
  • Ithaca, NY
  • NPI 1245256882
  NPD (past)
• Court Street Chiropractic of Ithaca, P.C.

  • Chiropractor
  • Ithaca, NY
  • NPI 1942305743
  NPD (past)

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1386721371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 WEST COURT ST",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "14850",
            "telephone_number": "607-275-3675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 WEST COURT ST",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "14850",
            "telephone_number": "607-275-3675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JERDAN",
        "first_name": "DIANE",
        "middle_name": "S",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R0507620",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shane Clinton Jaynes, LCSWR
• Farla Jean-Louis, MD
• Kaysha Jean, M.D.
• Bohdan Jemetz, O.D.
• Jessica Jenkins
• Jordan Victoria Jessop, RN
• Christopher John Jester, OD
• Samuel Jett, LMT
• Vantasia Joe
• John-Paul Mead, M.D., PLLC (Tompkins TMS)

• Clinical Social Worker in Ithaca, NY
• Providers in Ithaca, 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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.