Jaclyn Marie Vitkovsky

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

9168 Issued in CT

Practice address

503 New Harwinton Rd
Torrington, CT 06790-5845

Phone

(914) 552-2868

NPI assigned

Sep 18, 2020

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: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

North Star Behavioral Health Services LLCGroup PAC ID 4880028604, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• North Star Behavioral Health Services, LLC

  • Clinical Social Worker
  • Torrington, CT
  • NPI 1871141556
  Medicare reassignment Care Compare group NPD
• Behavioral Wellness Partners, LLC

  • Psychiatry Physician
  • Stamford, CT
  • NPI 1245848670
  NPD
• Northeast Therapy & Wellness LLC

  • Clinical Social Worker
  • Indian Orchard, MA
  • NPI 1619780384
  NPD

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

{
    "created_epoch": "1600387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604361600000",
    "number": "1508472259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "79 WOODSIDE CT",
            "city": "WATERTOWN",
            "state": "CT",
            "postal_code": "067951152",
            "telephone_number": "203-232-5397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503 NEW HARWINTON RD",
            "city": "TORRINGTON",
            "state": "CT",
            "postal_code": "067905845",
            "telephone_number": "914-552-2868"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "167 Cherry St # 101",
            "address_purpose": "LOCATION",
            "city": "Milford",
            "state": "CT",
            "postal_code": "064603466",
            "country_code": "US",
            "telephone_number": "203-524-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VITKOVSKY",
        "first_name": "JACLYN",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-18",
        "last_updated": "2020-11-03",
        "certification_date": "2020-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CT",
            "license": "107346",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CT",
            "license": "9168",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria Katrina Villanueva, M.D
• Dawn Vincent
• Jaclyn Helen Vincent, APRN
• Diana C Vincenzo, LCSW
• Yelena Vishnepolskaya, PHARMD.
• Susan Vontell, APRN
• Taylor Nicole Wachtarz, LPC
• Wal-Mart Stores East LP
• Keeley Walcott
• Walgreen Co

• Psychiatric/Mental Health Nurse Practitioner in Torrington, CT
• Providers in Torrington, CT by specialty
• Psychiatric/Mental Health Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2020; 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.