Individual provider Active NPI

Jane Skolnick, LCSW

  • Clinical Social Worker
  • Milford, CT
National Provider Identifier
1699873315
Registry record updated Aug 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
004049 Issued in CT
Practice address
949 Bridgeport Ave
Milford, CT 06460
Phone
(203) 878-6365
NPI assigned
Sep 20, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 4, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 004049 CT Primary

Addresses

Primary practice location

949 Bridgeport Ave
Milford, CT 06460

Mailing address

949 Bridgeport Ave
Milford, CT 06460-3142
Phone (203) 878-6365

Other identifiers 4

IdentifierTypeStateIssuer
004039244MedicaidCT
191103OtherCTMANAGED HEALTH NETWORK
140004049CT02OtherCTANTHEM PROVIDER NUMBER
000212554OtherCTUNITED BEHAVIORAL HEALTH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20110131000863 CT Practitioner - Clinical Social Worker 2264611680 Practice locations: Stratford, CT

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1129 Essex PL
Stratford, CT 06615-5867
Phone (203) 915-6519

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
004049CTMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
State of Connecticut PastSince Sep 29, 1998 Accepting new patients

Organizations & group practices 1

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": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659571200000",
    "number": "1699873315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "949 BRIDGEPORT AVE",
            "city": "MILFORD",
            "state": "CT",
            "postal_code": "064603142",
            "telephone_number": "203-878-6365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "949 BRIDGEPORT AVE",
            "city": "MILFORD",
            "state": "CT",
            "postal_code": "06460",
            "telephone_number": "203-878-6365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SKOLNICK",
        "first_name": "JANE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2022-08-04",
        "certification_date": "2022-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "004049",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004039244",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MANAGED HEALTH NETWORK",
            "identifier": "191103",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PROVIDER NUMBER",
            "identifier": "140004049CT02",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED BEHAVIORAL HEALTH",
            "identifier": "000212554",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milford, CT

Sources for this page

Verify at the official NPI Registry.