Individual provider Active NPI

Jessica Lynn Brinkmann

  • Mental Health Counselor
  • Middletown, NY
National Provider Identifier
1619506003
Registry record updated Apr 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
15 Fortune Rd W
Middletown, NY 10941-1625
Phone
(845) 421-0471
NPI assigned
Apr 7, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 7, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NY Primary

Addresses

Primary practice location

15 Fortune Rd W
Middletown, NY 10941-1625

Mailing address

1 Broadway Apt 306
Kingston, NY 12401-6041

Other practice location 1

1 Broadway Apt 306
Kingston, NY 12401-6041
Phone (845) 616-9925

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20240117003005 NY Practitioner - Mental Health Counselor 8527410331 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Access Supports for Living IncGroup PAC ID 8729992730, 41 clinicians

Practice addresses (Care Compare)

21 Grand St
Newburgh, NY 12550-5628
Phone (845) 562-7244

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Access: Supports for Living Inc Current Accepting new patients
Access: Supports for Living Inc CurrentSince Jan 1, 2024 Accepting new patients
Access: Supports for Living Inc. CurrentSince Jan 1, 2024 Accepting new patients

Locations

21 Grand St
Newburgh, NY 12550
Phone (845) 562-7244

67 Windsor Hwy
Newburgh, NY 12553
Phone (845) 562-6850

15 Fortune Rd W
Scotchtown, NY 10941
Phone (845) 673-7123

Organizations & group practices 3

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": "1586217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586217600000",
    "number": "1619506003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 BROADWAY APT 306",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "124016041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 FORTUNE RD W",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109411625",
            "telephone_number": "845-421-0471"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Broadway Apt 306",
            "address_purpose": "LOCATION",
            "city": "Kingston",
            "state": "NY",
            "postal_code": "124016041",
            "country_code": "US",
            "telephone_number": "845-616-9925",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRINKMANN",
        "first_name": "JESSICA",
        "middle_name": "LYNN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-04-07",
        "last_updated": "2020-04-07",
        "certification_date": "2020-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Middletown, NY

Sources for this page

Verify at the official NPI Registry.