Individual provider Active NPI

Jessica Screen, LCSW

  • Clinical Social Worker
  • Torrington, CT
National Provider Identifier
1609116029
Registry record updated Sep 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
007954 Issued in CT
Practice address
249 Winsted Rd
Torrington, CT 06790
Phone
(860) 496-3765
NPI assigned
Feb 21, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 007954 CT Primary

Addresses

Primary practice location

249 Winsted Rd
Torrington, CT 06790

Mailing address

64 Seymour St FL 2
Bristol, CT 06010-6822
Phone (860) 209-1910

Other names 1

  • Jessica Birmingham Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130606000567 CT Practitioner - Clinical Social Worker 2062650856 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

344 Watertown Rd
Thomaston, CT 06787-1921
Phone (203) 819-0789

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
007954CTMDClinical Social Worker
7954CTMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Connecticut Mental Health Specialists Inc Clinical CurrentSince Feb 24, 2020 Accepting new patients
State of Connecticut CurrentSince Oct 21, 2018 Accepting new patients
State of Connecticut CurrentSince Oct 21, 2018 Accepting new patients
Optum Behavioral Care of Connecticut, P.C. CurrentSince Jan 1, 2024 Accepting new patients
Optum Behavioral Care of Connecticut, P.C. Clinical CurrentSince Jan 1, 2024 Accepting new patients

Locations

270 Farmington Ave
Ste 309
Farmington, CT 06032
Phone (860) 677-5570

450 Columbus Blvd
Ste 1001
Hartford, CT 06103

169 Main St
Fl 3
Middletown, CT 06457
Phone (610) 618-6247

200 W Town St
Norwich, CT 06360
Phone (860) 886-1508

55 W Main St
Ste 410
Waterbury, CT 06702
Phone (203) 805-6408

Interoperability endpoints

  • Direct secure messaging: jessica.screen.1@28623.direct.athenahealth.com

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1361404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538006400000",
    "number": "1609116029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "64 SEYMOUR ST FL 2",
            "city": "BRISTOL",
            "state": "CT",
            "postal_code": "060106822",
            "telephone_number": "860-209-1910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "249 WINSTED RD",
            "city": "TORRINGTON",
            "state": "CT",
            "postal_code": "06790",
            "telephone_number": "860-496-3765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCREEN",
        "first_name": "JESSICA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-21",
        "last_updated": "2018-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "007954",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "BIRMINGHAM",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Torrington, CT

Sources for this page

Verify at the official NPI Registry.