Jillian Rae Humphrey, LMSW
Individual provider Active NPI School Social Worker · Pavilion, NY
NPI 1619854650 · NPPES record last updated Aug 20, 2025
Key facts
- NPI
- 1619854650
- Entity type
- Individual (NPI type 1)
- Primary specialty
- School Social Worker 1041S0200X
- License
- 128479 (NY)
- Practice address
- 7014 Big Tree Rd
Pavilion, NY 14525-9138 - Phone
- (585) 584-3115
- NPI assigned
- Aug 20, 2025
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 128479 | NY | MD | School Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pavilion Central School | Past |
Accepting new patients | |
| Pavilion Central School | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Social Worker | 1041S0200X | 128479 | NY | Yes |
Addresses
Primary practice location
7014 Big Tree Rd
Pavilion, NY 14525-9138
Mailing address
9694 Roanoke Rd
Stafford, NY 14143-9536
Phone (716) 983-8160
Other providers in Pavilion, NY
- Angels Heart Medical Transportation LLC
- Lydia Courtney
- Melissa E. Cutcliffe
- Miranda Feliciano
- Marie Lynn Hart
- Catherine C. Johns
- Nicole Lobello
- Pavilion Central School
- Pavilion Central School
- Danyle G Raines
All providers in Pavilion, NY · School Social Worker in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 20, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.