Active NPI
Jacqueline Lucille Renda, LCSW-R
- School Social Worker
- Port Jefferson, NY
National Provider Identifier
1700087434
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Social Worker
- License
- R039200-1
- Practice address
- 210 Emerson St
Port Jefferson, NY 11777-1605 - Phone
- (631) 331-3895
- NPI assigned
- May 30, 2007
- 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 | R039200-1 | NY | |
| School Social Worker | 1041S0200X | R039200-1 | NY | Primary |
Addresses
Primary practice location
210 Emerson St
Port Jefferson, NY 11777-1605
Mailing address
210 Emerson St
Port Jefferson, NY 11777-1605
Phone (631) 331-3895
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R039200-1 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180483200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1700087434",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 EMERSON ST",
"city": "PORT JEFFERSON",
"state": "NY",
"postal_code": "117771605",
"telephone_number": "631-331-3895"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 EMERSON ST",
"city": "PORT JEFFERSON",
"state": "NY",
"postal_code": "117771605",
"telephone_number": "631-331-3895"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RENDA",
"first_name": "JACQUELINE",
"middle_name": "LUCILLE",
"name_prefix": "Ms.",
"credential": "LCSW-R",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-30",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "R039200-1",
"primary": false
},
{
"code": "1041S0200X",
"taxonomy_group": "",
"desc": "Social Worker, School",
"state": "NY",
"license": "R039200-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Jefferson, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.