Active NPI
Jennifer A Gennosa, LMSW
- Clinical Social Worker
- Smithtown, NY
National Provider Identifier
1639189830
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 070869-1
- Practice address
- 11 Route 111
Smithtown, NY 11787-3712 - Phone
- (631) 920-8300
- NPI assigned
- Aug 9, 2006
- Sex
- Female
- 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 | 070869-1 | NY | Primary |
Addresses
Primary practice location
11 Route 111
Smithtown, NY 11787-3712
Mailing address
11 Route 111
Smithtown, NY 11787-3712
Phone (631) 920-8300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070869-1 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1639189830",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 ROUTE 111",
"city": "SMITHTOWN",
"state": "NY",
"postal_code": "117873712",
"telephone_number": "631-920-8300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11 ROUTE 111",
"city": "SMITHTOWN",
"state": "NY",
"postal_code": "117873712",
"telephone_number": "631-920-8300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GENNOSA",
"first_name": "JENNIFER",
"middle_name": "A",
"name_prefix": "Mrs.",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "070869-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Smithtown, NY
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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.