Jay Bastian LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

34007970A Issued in IN

Legal business name

JAY BASTIAN LLC

Practice address

9329 Illinois Rd
Fort Wayne, IN 46804-5796

Phone

(260) 418-9653

NPI assigned

Feb 20, 2018

Organization subpart

No

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

Authorized official

Name

Mr. Jay Alan Bastian, LCSWNPI 1912363375

Title

Psychotherapist

Phone

(260) 418-9653

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jay Alan Bastian, LCSW

  • Social Worker
  • Fort Wayne, IN
  • NPI 1912363375
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1519084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729900800000",
    "number": "1740780204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9329 ILLINOIS RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468045796",
            "telephone_number": "260-418-9653",
            "fax_number": "260-209-0762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9329 ILLINOIS RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468045796",
            "telephone_number": "260-418-9653"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5420 Sherington Rd",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468147510",
            "country_code": "US",
            "telephone_number": "260-418-9653",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JAY BASTIAN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-20",
        "last_updated": "2024-10-26",
        "certification_date": "2024-10-26",
        "status": "A",
        "authorized_official_last_name": "BASTIAN",
        "authorized_official_first_name": "JAY",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "PSYCHOTHERAPIST",
        "authorized_official_telephone_number": "260-418-9653",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34007970A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Teresa A. Jarrell, LCAC
• Rachel Jarvis
• Rachel Jarvis
• Kori Jasper, BS
• Jaspreet S Jawanda, M.D.
• Jay Shree Ganesh Inc
• Jithmie Jayawickrema, PT
• Vimal Jayswal, MD
• Erica Marie Jefferies, FNP
• Jennifer Lyn Jefferies, RBT

• Clinical Social Worker in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Clinical Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.