Suzanne Jacob-Muccino

Primary specialty

Social WorkerTaxonomy code 104100000X

Practice address

141 E Main St
Waterbury, CT 06702-2310

Phone

(203) 574-9000

Fax

(203) 574-9006

NPI assigned

Dec 13, 2019

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 CT

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Community Health and Wellness Center of Greater Torrington Inc

  • Primary Care Clinic/Center
  • Torrington, CT
  • NPI 1356318091
  Medicare reassignment NPD
• Community Health and Wellness Center of Greater Torrington Inc

  • Federally Qualified Health Center (FQHC)
  • Winsted, CT
  • NPI 1902757149
  NPD

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

{
    "created_epoch": "1576195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582588800000",
    "number": "1396383071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 E MAIN ST",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067022310",
            "telephone_number": "203-574-9000",
            "fax_number": "203-574-9006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 E MAIN ST",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067022310",
            "telephone_number": "203-574-9000",
            "fax_number": "203-574-9006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB-MUCCINO",
        "first_name": "SUZANNE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-13",
        "last_updated": "2020-02-25",
        "certification_date": "2020-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yasmin Jaber, MD
• Edward H. Jaccoma, M.D.
• Jamia J Jackson, BA
• Louis E Jackson, AS
• Thomas A. Jackson
• Mauria Jacobi
• Kevin J. Jacobs, PT
• Peter James Jacoby, MD
• Mackenna Jacovich
• M. Amy Jagoda, AUDIOLOGIST

• Social Worker in Waterbury, CT
• Providers in Waterbury, CT by specialty
• Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2020; 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.