Jared Whipple
Individual provider Active NPI Social Worker · Manchester, CT
NPI 1780191585 · NPPES record last updated Feb 20, 2019
Key facts
- NPI
- 1780191585
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- Practice address
- 444 Center St
Manchester, CT 06040-3926 - Phone
- (860) 646-3888
- Fax
- (860) 645-4132
- NPI assigned
- Jan 3, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240209000109 | CT | Practitioner - Mental Health Counselor | 3971946625 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sojourn Counseling LLC | Mental Health | Current |
Accepting new patients |
| Community Health Resources, Inc. | Current |
Accepting new patients | |
| Community Services Northwest | Past | Accepting new patients |
Locations
474 School St
#R
East Hartford, CT 06108
Phone (860) 730-8811
153 Hazard Ave
Enfield, CT 06082
Phone (860) 253-5020
444 Center St
Manchester, CT 06040
Phone (860) 646-3888
2 Waterside Xing
Ste 401
Windsor, CT 06095
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Social Worker | 104100000X | Yes |
Addresses
Primary practice location
444 Center St
Manchester, CT 06040-3926
Mailing address
PO Box 1845
Vancouver, WA 98668-1845
Phone (360) 397-8484
Other practice location 1
9300 NE Oak View Dr
Vancouver, WA 98662-6157
Phone (360) 397-8484
Other providers in Manchester, CT
- Michael Westfall
- Taryn Westfall
- Westown Pharmacy Inc
- Westside Care Center LLC
- Cassandra L Wheeler
- Kaitlyn R Whipple
- Faith Elizabeth Whitbeck
- Stephanie White
- Quashaun J Whitehead
- Shelby Whitley
All providers in Manchester, CT · Social Worker in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 20, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.