Jennifer Macleod Baxendale, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

121400 Issued in MA

Practice address

1 Fenn St
Administrative Offices
Pittsfield, MA 01201-6278

Phone

(413) 629-1262

Fax

(413) 448-2198

NPI assigned

Aug 31, 2010

Last updated

Nov 21, 2018By 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

Other names 1

• Jennifer Baxendale Lally Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1283212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542758400000",
    "number": "1750697538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 EAST STREET",
            "address_2": "BRIEN CENTER",
            "city": "PITTSFIELD",
            "state": "MA",
            "postal_code": "012016278",
            "telephone_number": "413-629-1086",
            "fax_number": "413-448-2198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 FENN ST",
            "address_2": "ADMINISTRATIVE OFFICES",
            "city": "PITTSFIELD",
            "state": "MA",
            "postal_code": "012016278",
            "telephone_number": "413-629-1262",
            "fax_number": "413-448-2198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAXENDALE",
        "first_name": "JENNIFER",
        "middle_name": "MACLEOD",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-08-31",
        "last_updated": "2018-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "121400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1750697538",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "LALLY",
            "middle_name": "BAXENDALE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Clinical Social Worker in Pittsfield, MA
• Providers in Pittsfield, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2018; 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.