Active NPI
Jack Laney Skelton, LCSW, MA
- Clinical Social Worker
- Brooklyn, NY
National Provider Identifier
1407563190
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 093795-01
- Practice address
- 289 Empire Blvd Apt 2C
Brooklyn, NY 11225-3539 - Phone
- (315) 406-5124
- NPI assigned
- Nov 1, 2022
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 093795-01 | NY | Primary |
Addresses
Primary practice location
289 Empire Blvd Apt 2C
Brooklyn, NY 11225-3539
Mailing address
289 Empire Blvd Apt 2C
Brooklyn, NY 11225-3539
Phone (315) 406-5124
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)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 093795-01 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1667260800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667260800000",
"number": "1407563190",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "289 EMPIRE BLVD APT 2C",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112253539",
"telephone_number": "315-406-5124"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "289 EMPIRE BLVD APT 2C",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112253539",
"telephone_number": "315-406-5124"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SKELTON",
"first_name": "JACK",
"middle_name": "LANEY",
"credential": "LCSW, MA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-11-01",
"last_updated": "2022-11-01",
"certification_date": "2022-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "093795-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.