Active NPI
Jeanette Marlene Tyson, L.C.S.W.
- Social Worker
- South Orange, NJ
National Provider Identifier
1407059793
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 44SL05287200
- Practice address
- 160 Garfield PL
South Orange, NJ 07079-2107 - Phone
- (973) 738-3823
- NPI assigned
- Jun 6, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 44SL05287200 | NJ | Primary |
Addresses
Primary practice location
160 Garfield PL
South Orange, NJ 07079-2107
Mailing address
160 Garfield PL
South Orange, NJ 07079-2107
Phone (973) 738-3823
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 160092 | Other | NJ | MEDICARE TPAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 44SL05287200 | NJ | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jeni Tyson LCSW LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinical Social Worker
- Maplewood, NJ
- NPI 1427466838
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1638489600000",
"number": "1407059793",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "160 GARFIELD PL",
"city": "SOUTH ORANGE",
"state": "NJ",
"postal_code": "070792107",
"telephone_number": "973-738-3823"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "160 GARFIELD PL",
"city": "SOUTH ORANGE",
"state": "NJ",
"postal_code": "070792107",
"telephone_number": "973-738-3823"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TYSON",
"first_name": "JEANETTE",
"middle_name": "MARLENE",
"credential": "L.C.S.W.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-06",
"last_updated": "2021-12-03",
"certification_date": "2021-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NJ",
"license": "44SL05287200",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE TPAN",
"identifier": "160092",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in South Orange, NJ
- Township of South Orange Village
- Catherine Trossello, FNP
- Tucker Drugs Inc (South Orange Drugs)
- Megan Twomey
- Erin Michelle Tyler
- Unity Optometric Health Service,P.a.
- Urogynecology and Advanced Gynecology Medical Group PA
- Valley Healthcare Services LLC
- Laura Ann Vandyke, LCSW
- Vascular Access Center of South Orange LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.