Individual provider Active NPI

Jennifer Lauren Koon, LMSW

  • Clinical Social Worker
  • Oswego, NY
National Provider Identifier
1770859902
Registry record updated Apr 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
085576-1 Issued in NY
Practice address
74 Bunner St
Oswego, NY 13126-3357
Phone
(315) 326-4100
NPI assigned
Apr 2, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 085576-1 NY Primary

Addresses

Primary practice location

74 Bunner St
Oswego, NY 13126-3357

Mailing address

74 Bunner St
Oswego, NY 13126-3357
Phone (315) 326-4100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20200602002219 NY Practitioner - Clinical Social Worker 8426479262 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2010
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

208 Easterly Ter
Syracuse, NY 13214-2316
Phone (315) 884-0545

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
085576-1NYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Koon Counseling Services LMSW, P.C. CurrentSince Feb 2, 2020 Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1333324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1333324800000",
    "number": "1770859902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "74 BUNNER ST",
            "city": "OSWEGO",
            "state": "NY",
            "postal_code": "131263357",
            "telephone_number": "315-326-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "74 BUNNER ST",
            "city": "OSWEGO",
            "state": "NY",
            "postal_code": "131263357",
            "telephone_number": "315-326-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOON",
        "first_name": "JENNIFER",
        "middle_name": "LAUREN",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-02",
        "last_updated": "2012-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "085576-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oswego, NY

Sources for this page

Verify at the official NPI Registry.