Active NPI
Jillian Derosas, LCSW
- Clinical Social Worker
- West Hartford, CT
National Provider Identifier
1679229132
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 14069
- Practice address
- 846 Farmington Ave Ste 4
West Hartford, CT 06119-1554 - Phone
- (571) 427-0740
- NPI assigned
- Feb 23, 2022
- Last updated
- May 31, 2024
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 14069 | CT | Primary |
| School Social Worker | 1041S0200X | NU |
Addresses
Primary practice location
846 Farmington Ave Ste 4
West Hartford, CT 06119-1554
Mailing address
43 Hilltop Dr
West Hartford, CT 06107-1434
Other practice location 1
822 S Clearview Pkwy
Harahan, LA 70123-3401
Phone (504) 736-1800
Other practice location 2
43 Hilltop Dr
West Hartford, CT 06107-1434
Phone (781) 820-1651
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1701033 | Medicaid | LA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14069 | CT | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1645574400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717113600000",
"number": "1679229132",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "43 HILLTOP DR",
"city": "WEST HARTFORD",
"state": "CT",
"postal_code": "061071434"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "846 FARMINGTON AVE STE 4",
"city": "WEST HARTFORD",
"state": "CT",
"postal_code": "061191554",
"telephone_number": "571-427-0740"
}
],
"practiceLocations": [
{
"address_1": "822 S Clearview Pkwy",
"address_purpose": "LOCATION",
"city": "Harahan",
"state": "LA",
"postal_code": "701233401",
"country_code": "US",
"telephone_number": "504-736-1800",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "43 Hilltop Dr",
"address_purpose": "LOCATION",
"city": "West Hartford",
"state": "CT",
"postal_code": "061071434",
"country_code": "US",
"telephone_number": "781-820-1651",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DEROSAS",
"first_name": "JILLIAN",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-02-23",
"last_updated": "2024-05-31",
"certification_date": "2024-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CT",
"license": "14069",
"primary": true
},
{
"code": "1041S0200X",
"taxonomy_group": "",
"desc": "Social Worker, School",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1701033",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Hartford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.