Individual provider Active NPI

Jennifer Paris, LICSW

  • Clinical Social Worker
  • Manchester, NH
National Provider Identifier
1417189077
Registry record updated Apr 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
1908 Issued in NH
Practice address
1555 Elm St
Manchester, NH 03101-1203
Phone
(603) 668-4111
Fax
(603) 628-7757
NPI assigned
Aug 17, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 1908 NH Primary

Addresses

Primary practice location

1555 Elm St
Manchester, NH 03101-1203

Mailing address

2 Wall St Ste 300
Manchester, NH 03101-1518
Phone (603) 668-4111

Other names 1

  • Jennifer Boudreau Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address TheMentalHealthCenterofGreaterManchester@mhcgm.netsmartdirect.net Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH
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

Enrollment IDStateProvider typePAC IDDetails
I20160229001421 NH Practitioner - Clinical Social Worker 7911202932 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Mental Health Center of Greater ManchesterGroup PAC ID 6709874274, 86 clinicians

Practice addresses (Care Compare)

2 Wall St
Manchester, NH 03101-1518
Phone (603) 668-4111

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

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.

NPI Registry JSON

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

{
    "created_epoch": "1250467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617235200000",
    "number": "1417189077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 WALL ST STE 300",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031011518",
            "telephone_number": "603-668-4111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 ELM ST",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031011203",
            "telephone_number": "603-668-4111",
            "fax_number": "603-628-7757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARIS",
        "first_name": "JENNIFER",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-17",
        "last_updated": "2021-04-01",
        "certification_date": "2021-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NH",
            "license": "1908",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "TheMentalHealthCenterofGreaterManchester@mhcgm.netsmartdirect.net",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "1555 Elm St",
            "city": "Manchester",
            "state": "NH",
            "country_code": "US",
            "postal_code": "031011203",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "BOUDREAU",
            "credential": "LICSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Manchester, NH

Sources for this page

Verify at the official NPI Registry.