Mary Jeanbyk, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

003902 Issued in CT

Practice address

5 Church LN Ste 5
East Lyme, CT 06333-1621

Phone

(860) 235-1748

NPI assigned

May 7, 2015

Last updated

May 7, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1430956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430956800000",
    "number": "1689052946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37 MONTICELLO DR",
            "city": "EAST LYME",
            "state": "CT",
            "postal_code": "063331231",
            "telephone_number": "860-235-1748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 CHURCH LN STE 5",
            "city": "EAST LYME",
            "state": "CT",
            "postal_code": "063331621",
            "telephone_number": "860-235-1748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEANBYK",
        "first_name": "MARY",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-05-07",
        "last_updated": "2015-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "003902",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "13506405",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Healthsource of East Lyme LLC
• Patricia Healy
• Elizabeth Henry
• Hong Qi Acupuncture and Wellness Center
• Inside Out Wellness LLC
• Kim John Kaiser
• Archana Karanki, DMD
• Kathleen Corcoran Karlberg, PT
• Daniel W Kerzner, D.C.
• Prakash Keshary

• Clinical Social Worker in East Lyme, CT
• Providers in East Lyme, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.