Individual provider Active NPI

Jacqueline Elizabeth Carroll

  • Marriage & Family Therapist
  • Jersey City, NJ
National Provider Identifier
1629560784
Registry record updated Jul 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
37FA00015600 Issued in NJ
Practice address
444 Warren St Apt 357
Jersey City, NJ 07302-7201
Phone
(551) 655-0006
Fax
(201) 567-9335
NPI assigned
Jun 5, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 37FA00015600 NJ Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X

Addresses

Primary practice location

444 Warren St Apt 357
Jersey City, NJ 07302-7201

Mailing address

444 Warren St Apt 357
Jersey City, NJ 07302-7201
Phone (551) 655-0006

Other names 1

  • Jacqueline Elizabeth Ramos Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20241231003619 NJ Practitioner - Marriage and Family Therapist 4789111873 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Forge Medical Group, LLCGroup PAC ID 5597163949, 35 clinicians

Practice addresses (Care Compare)

1500 Pleasant Valley Way
Suite 305
West Orange, NJ 07052-2956
Phone (862) 658-6700

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
37FA00015600NJMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Forge Medical Group, LLC CurrentSince Dec 2, 2024 Accepting new patients
Forge Medical Group, LLC CurrentSince Dec 2, 2024 Accepting new patients

Locations

1500 Pleasant Valley Way
Ste 305
West Orange, NJ 07052
Phone (862) 658-6700

10 Bank St
Ste 830
White Plains, NY 10606
Phone (888) 224-7312

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.

NPI Registry JSON

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

{
    "created_epoch": "1528156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720656000000",
    "number": "1629560784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "444 WARREN ST APT 357",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073027201",
            "telephone_number": "551-655-0006",
            "fax_number": "201-567-9335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "444 WARREN ST APT 357",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073027201",
            "telephone_number": "551-655-0006",
            "fax_number": "201-567-9335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "JACQUELINE",
        "middle_name": "ELIZABETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-05",
        "last_updated": "2024-07-11",
        "certification_date": "2024-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NJ",
            "license": "37FA00015600",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "RAMOS",
            "middle_name": "ELIZABETH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Jersey City, NJ

Sources for this page

Verify at the official NPI Registry.