Active NPI
Jensen M Moon, LISW
- Clinical Social Worker
- Canton, OH
National Provider Identifier
1790236792
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- I.2102686
- Practice address
- 1341 Market Ave N
Canton, OH 44714-2605 - Phone
- (330) 453-8252
- Fax
- (330) 452-4655
- NPI assigned
- Oct 14, 2016
- Last updated
- Jan 30, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | I.2102686 | OH | Primary |
Addresses
Primary practice location
1341 Market Ave N
Canton, OH 44714-2605
Mailing address
625 Cleveland Ave NW
Canton, OH 44702-1805
Phone (330) 453-8252
Other practice location 1
1680 Nave Rd SE
Massillon, OH 44646-9604
Phone (330) 830-8740
Other practice location 2
1207 W State St Ste M
Alliance, OH 44601-4686
Phone (330) 821-8407
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0273660 | Medicaid | OH |
Other names 1
- Jensen M Dearment
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| I.2102686 | OH | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1476403200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675036800000",
"number": "1790236792",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "625 CLEVELAND AVE NW",
"city": "CANTON",
"state": "OH",
"postal_code": "447021805",
"telephone_number": "330-453-8252",
"fax_number": "330-453-6716"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1341 MARKET AVE N",
"city": "CANTON",
"state": "OH",
"postal_code": "447142605",
"telephone_number": "330-453-8252",
"fax_number": "330-452-4655"
}
],
"practiceLocations": [
{
"address_1": "1680 Nave Rd SE",
"address_purpose": "LOCATION",
"city": "Massillon",
"state": "OH",
"postal_code": "446469604",
"country_code": "US",
"telephone_number": "330-830-8740",
"fax_number": "330-830-0912",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1207 W State St Ste M",
"address_purpose": "LOCATION",
"city": "Alliance",
"state": "OH",
"postal_code": "446014686",
"country_code": "US",
"telephone_number": "330-821-8407",
"fax_number": "330-821-8506",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MOON",
"first_name": "JENSEN",
"middle_name": "M",
"credential": "LISW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-10-14",
"last_updated": "2023-01-30",
"certification_date": "2023-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OH",
"license": "I.2102686",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0273660",
"state": "OH"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JENSEN",
"last_name": "DEARMENT",
"middle_name": "M",
"credential": "LISW",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Canton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.