Jaclyn Czerniak, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Practice address

880 Burbank Ave
Suffield, CT 06078-1459

Phone

(860) 539-6736

NPI assigned

Feb 7, 2014

Last updated

Mar 24, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wheeler Clinic IncGroup PAC ID 0345147153, 105 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jaclyn.czerniak.p1@direct.wheelerclinic.nextgenshare.com

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.

• Wheeler Clinic Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Plainville, CT
  • NPI 1396750840
  Medicare reassignment Care Compare group NPD
• Wheeler Clinic Inc

  • Federally Qualified Health Center (FQHC)
  • Bristol, CT
  • NPI 1790532802
  NPD

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

{
    "created_epoch": "1391731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648080000000",
    "number": "1487078762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 605",
            "city": "SUFFIELD",
            "state": "CT",
            "postal_code": "060780605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "880 BURBANK AVE",
            "city": "SUFFIELD",
            "state": "CT",
            "postal_code": "060781459",
            "telephone_number": "860-539-6736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CZERNIAK",
        "first_name": "JACLYN",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-02-07",
        "last_updated": "2022-03-24",
        "certification_date": "2022-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peter Leighton Coombs, D.M.D.
• Correctional Manageed Health Care
• Eden Corridon, LPC
• John A. Crosson
• Amanda M Cuevas, CT-LCSW
• D4 Performance Lab
• Dahlia Counseling Services, LLC
• Anna Catherine Davenport, LMFT
• Heidi Suzanne Deflorio, P.T.
• Josephine Diaz

• Professional Counselor in Suffield, CT
• Providers in Suffield, CT by specialty
• Professional Counselor in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.