Individual provider Active NPI

Jeanette Miller, LISW-S

  • Clinical Social Worker
  • Cleveland, OH
National Provider Identifier
1770854218
Registry record updated May 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
I.0009197 Issued in OH
Practice address
3500 Carnegie Ave
Cleveland, OH 44115-2641
Phone
(440) 314-5245
NPI assigned
Jan 13, 2012
Last updated
May 2, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X I 0009197 OH
Clinical Social Worker 1041C0700X I.0009197 OH Primary

Addresses

Primary practice location

3500 Carnegie Ave
Cleveland, OH 44115-2641

Mailing address

3500 Carnegie Ave
Cleveland, OH 44115-2641
Phone (440) 314-5245

Other identifiers 1

IdentifierTypeStateIssuer
1770854218MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20220628000520 OH Practitioner - Clinical Social Worker 1557740172 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Psychological and Behavioral Consultants LLCGroup PAC ID 0446243760, 595 clinicians

Practice addresses (Care Compare)

25101 Chagrin Blvd
Suite 100
Beachwood, OH 44122-5694
Phone (216) 831-6611

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
I 0009197OHMDSocial Worker
I.0009197OHMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Psychological & Behavioral Consultants, LLC Clinical CurrentSince May 1, 2022 Accepting new patients

Locations

25101 Chagrin Blvd
Ste 100
Beachwood, OH 44122
Phone (216) 245-4468

25111 Country Club Blvd
Ste 290
North Olmsted, OH 44070
Phone (440) 614-2520

13550 Falling Water Rd
Ste 300
Strongsville, OH 44136
Phone (440) 998-7541

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1326412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651449600000",
    "number": "1770854218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 CARNEGIE AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441152641",
            "telephone_number": "440-314-5245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 CARNEGIE AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441152641",
            "telephone_number": "440-314-5245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "JEANETTE",
        "credential": "LISW-S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-01-13",
        "last_updated": "2022-05-02",
        "certification_date": "2022-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "I 0009197",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.0009197",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1770854218",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

Verify at the official NPI Registry.