Active NPI
Jeffrey P Hodnicki, LCSW
- Clinical Social Worker
- Bridgeport, CT
National Provider Identifier
1598823833
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 002862
- Practice address
- 1635 Central Avenue
Southwest Connecticut Mental Health System
Bridgeport, CT 06610 - Phone
- (203) 551-7660
- Fax
- (203) 551-7481
- NPI assigned
- Dec 5, 2006
- Sex
- Male
- Sole proprietor
- No
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 | 002862 | CT | Primary |
Addresses
Primary practice location
1635 Central Avenue
Southwest Connecticut Mental Health System
Bridgeport, CT 06610
Mailing address
1635 Central Avenue Room 213
Southwest CT Mental Health System
Bridgeport, CT 06610
Phone (203) 551-7660
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 |
|---|---|---|---|
| 002862 | CT | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| State of Connecticut | Past | Accepting new patients | |
| State of Connecticut | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Skilled Nursing Facility
- Rocky Hill, CT
- NPI 1205951662
-
- Psychiatric Hospital
- Bridgeport, CT
- NPI 1720013360
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1598823833",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1635 CENTRAL AVENUE ROOM 213",
"address_2": "SOUTHWEST CT MENTAL HEALTH SYSTEM",
"city": "BRIDGEPORT",
"state": "CT",
"postal_code": "06610",
"telephone_number": "203-551-7660",
"fax_number": "203-551-7481"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1635 CENTRAL AVENUE",
"address_2": "SOUTHWEST CONNECTICUT MENTAL HEALTH SYSTEM",
"city": "BRIDGEPORT",
"state": "CT",
"postal_code": "06610",
"telephone_number": "203-551-7660",
"fax_number": "203-551-7481"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HODNICKI",
"first_name": "JEFFREY",
"middle_name": "P",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CT",
"license": "002862",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Bridgeport, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.