Jennifer Brown, LCSW
Individual provider Active NPI Clinical Social Worker · Fortuna, CA
NPI 1568709269 · NPPES record last updated Mar 10, 2021
Key facts
- NPI
- 1568709269
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 29128 (CA)
- Practice address
- 3429 Renner Dr
Fortuna, CA 95540-3104 - Phone
- (707) 296-9295
- Fax
- (707) 324-0314
- NPI assigned
- Jan 15, 2013
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Humboldt Neurohealth Therapeutic Services
Practice addresses (Care Compare)
3429 Renner Dr
Fortuna, CA 95540-3104
Phone (707) 296-9295
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160803000118 | CA | Practitioner - Clinical Social Worker | 2668766445 |
Reassigns benefits to 1 organization Practice locations: Eureka, CA |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29128 | CA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Humboldt Neurohealth Therapeutic Services | Clinical | Current |
Accepting new patients |
| Humboldt Neurohealth Therapeutic Services | Current | Accepting new patients |
Locations
2145 Myrtle Ave
Eureka, CA 95501
Phone (707) 296-9295
3429 Renner Dr
Fortuna, CA 95540
Phone (707) 296-9295
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 29128 | CA | Yes |
Addresses
Primary practice location
3429 Renner Dr
Fortuna, CA 95540-3104
Mailing address
3429 Renner Dr
Fortuna, CA 95540-3104
Phone (707) 296-9295
Other providers in Fortuna, CA
- Diederik-Jan Frederick Bouwmeester
- Ashley Megan Bramlett
- Nathan Dario Brinckhaus
- Ruben E Brinckhaus
- Broadway Medical Service & Supply, Inc
- Kelly Usborne Bruce
- Andrey Buie
- Susan Burgess
- Joan P. Butler
- Brian Calvert
All providers in Fortuna, CA · Clinical Social Worker in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 10, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.