Active NPI
Jenna Bracco, LICENSED CLINICAL SO
- Clinical Social Worker
- Eugene, OR
National Provider Identifier
1497205306
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- L7048
- Practice address
- 1274 W. 7TH Avenue Suite 201
Eugene, OR 97402 - Phone
- (804) 405-8452
- NPI assigned
- Oct 4, 2016
- Reactivated
- Mar 26, 2019
- Sex
- Female
- 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 | L7048 | OR | Primary |
Addresses
Primary practice location
1274 W. 7TH Avenue Suite 201
Eugene, OR 97402
Mailing address
1274 W. 7TH Avenue Suite 201
Eugene, OR 97402
Phone (804) 405-8452
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L7048 | OR | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1475539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1553558400000",
"number": "1497205306",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1274 W. 7TH AVENUE SUITE 201",
"city": "EUGENE",
"state": "OR",
"postal_code": "97402",
"telephone_number": "804-405-8452"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1274 W. 7TH AVENUE SUITE 201",
"city": "EUGENE",
"state": "OR",
"postal_code": "97402",
"telephone_number": "804-405-8452"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRACCO",
"first_name": "JENNA",
"name_prefix": "Miss",
"credential": "LICENSED CLINICAL SO",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-10-04",
"last_updated": "2019-03-26",
"deactivation_date": "2017-04-17",
"reactivation_date": "2019-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OR",
"license": "L7048",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eugene, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.