Jill J. Wynn, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

094974 Issued in NY

Practice address

220 5TH Ave FL 11
New York, NY 10001-8017

Phone

(212) 564-0480

Fax

(833) 464-5058

NPI assigned

Apr 18, 2023

Last updated

Mar 14, 2024By 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

Medicare fee-for-service enrollment

Enrolled in NY, NJ2 enrollments

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 2

Specialty

Clinical Social Worker

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Inpresent Psychiatry PCGroup PAC ID 4981081601, 14 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jill.wynn.1@25072.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Rappore Medicine PC

  • Psychiatry Physician
  • New York, NY
  • NPI 1699301614
  Medicare reassignment Care Compare group NPD
• Inpresent Psychiatry PC

  • Psychiatry Physician
  • Chevy Chase, MD
  • NPI 1932971876
  NPD
• Rappore Medicine NJ PC

  • Psychiatry Physician
  • Hoboken, NJ
  • NPI 1154173003
  NPD

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

{
    "created_epoch": "1681776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710374400000",
    "number": "1710674080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "442 5TH AVE # 1983",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100182794",
            "telephone_number": "253-648-0340",
            "fax_number": "206-673-8050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 5TH AVE FL 11",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100018017",
            "telephone_number": "212-564-0480",
            "fax_number": "833-464-5058"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "108 Battle Green Dr",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "NY",
            "postal_code": "146244952",
            "country_code": "US",
            "telephone_number": "585-455-6878",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WYNN",
        "first_name": "JILL",
        "middle_name": "J.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-04-18",
        "last_updated": "2024-03-14",
        "certification_date": "2024-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "094974",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alyssa Wynn, LCSW
• Cymone Wynn
• Danielle Wynn
• Dejuan Lamont Wynn, OPTICIAN
• Eleanor Grace Wynn, MHC-LP
• Julia Wynn, MS, CGC
• Kristin Wynn, LCSW
• Laura Wynn, MSW
• Laura Wynne, LMSW
• Eudis D Wynns

• Clinical Social Worker in New York, NY
• Providers in New York, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.