Active NPI
Jay Robert Sheridan, LCSW
- Clinical Social Worker
- Manchester, CT
National Provider Identifier
1407816101
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 005714
- Practice address
- 71 Haynes St
Manchester, CT 06040-4131 - Phone
- (860) 646-1222
- Fax
- (860) 533-3452
- NPI assigned
- Mar 25, 2006
- Last updated
- Oct 6, 2015
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 005714 | CT | Primary |
Addresses
Primary practice location
71 Haynes St
Manchester, CT 06040-4131
Mailing address
71 Haynes St
BH Administration Department
Manchester, CT 06040-4131
Phone (860) 533-3494
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 005714 | CT | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eastern Connecticut Medical Professionals Foundation, Inc | Past | Accepting new patients | |
| Eastern Connecticut Medical Professionals Foundation Inc | Clinical | Past | Accepting new patients |
Organizations & group practices 4
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.
-
- General Acute Care Hospital
- Manchester, CT
- NPI 1316394638
-
- General Acute Care Hospital
- Vernon, CT
- NPI 1205283538
-
dba Eastern CT Medical Professionals
- Family Medicine Physician
- Manchester, CT
- NPI 1770557712
Clinical
-
dba Eastern Orthopeadics and Sports Medicine, PC
- Specialist
- South Windsor, CT
- NPI 1497864516
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143244800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1444089600000",
"number": "1407816101",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "71 HAYNES ST",
"address_2": "BH ADMINISTRATION DEPARTMENT",
"city": "MANCHESTER",
"state": "CT",
"postal_code": "060404131",
"telephone_number": "860-533-3494",
"fax_number": "860-647-6831"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "71 HAYNES ST",
"city": "MANCHESTER",
"state": "CT",
"postal_code": "060404131",
"telephone_number": "860-646-1222",
"fax_number": "860-533-3452"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHERIDAN",
"first_name": "JAY",
"middle_name": "ROBERT",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-25",
"last_updated": "2015-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CT",
"license": "005714",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manchester, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2015; 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.