Jennifer Clark, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

006060 Issued in CT

Practice address

72 Route 32
North Franklin, CT 06254-1810

Phone

(860) 917-0790

Fax

(860) 367-0342

NPI assigned

Nov 13, 2006

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

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.

Opted out of Medicare

Yes, effective Apr 1, 2019 through Apr 1, 2027

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

• Inner Peace CT

  • Clinical Social Worker
  • Waterford, CT
  • NPI 1710228036
  NPD (past) Authorized official

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1417028937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 LIBERTY RD",
            "city": "OAKDALE",
            "state": "CT",
            "postal_code": "063701211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72 ROUTE 32",
            "city": "NORTH FRANKLIN",
            "state": "CT",
            "postal_code": "062541810",
            "telephone_number": "860-917-0790",
            "fax_number": "860-367-0342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JENNIFER",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-13",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "006060",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jadira Eloise Breault, LPC
• Aaron Josef Bujdos, DPT
• Laura I Burke, M.A.
• Ryan Capizzano
• Mark David Carper
• Laura Collelo
• Adem Lutfi Cosgel, PA-C
• Jennifer Davis-Muller, NCC, LPC
• Laura Caroline Dawson, LCSW
• Kelsey Welsh Depriest, PA-C

• Clinical Social Worker in North Franklin, CT
• Providers in North Franklin, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.