Active NPI
Jocelyn J Butler, MSW LCSW
- Clinical Social Worker
- Fort Wayne, IN
National Provider Identifier
1528166873
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 34000879
- Practice address
- 6335 Constitution Dr
Fort Wayne, IN 46804-1547 - Phone
- (260) 436-5353
- Fax
- (260) 436-5399
- NPI assigned
- Sep 20, 2006
- 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 | 34000879 | IN | Primary |
Addresses
Primary practice location
6335 Constitution Dr
Fort Wayne, IN 46804-1547
Mailing address
6335 Constitution Dr
Fort Wayne, IN 46804-1547
Phone (260) 436-5353
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 028606 | Other | IN | VALUE OPTIONS PROVIDER |
| 090721 | Other | IN | MANAGED HEALTH NETWORK |
| 000000374537 | Other | IN | ANTHEM PROVIDER NUMBER |
| 059800000 | Other | IN | MAGELLAN PROVIDER NUMBER |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34000879 | IN | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Powers Psychological Services LLC | Past | Accepting new patients |
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.
-
- Clinical Psychologist
- Fort Wayne, IN
- NPI 1912121070
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1469145600000",
"number": "1528166873",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6335 CONSTITUTION DR",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468041547",
"telephone_number": "260-436-5353",
"fax_number": "260-436-5399"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6335 CONSTITUTION DR",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468041547",
"telephone_number": "260-436-5353",
"fax_number": "260-436-5399"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUTLER",
"first_name": "JOCELYN",
"middle_name": "J",
"credential": "MSW LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-20",
"last_updated": "2016-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IN",
"license": "34000879",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS PROVIDER",
"identifier": "028606",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MANAGED HEALTH NETWORK",
"identifier": "090721",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM PROVIDER NUMBER",
"identifier": "000000374537",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN PROVIDER NUMBER",
"identifier": "059800000",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.