Individual provider Active NPI

Jennifer L Johnston

  • Clinical Social Worker
  • Buffalo, NY
National Provider Identifier
1790822237
Registry record updated Nov 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
070121 Issued in NY
Practice address
505 Ellicott St
Buffalo, NY 14203-1547
Phone
(888) 975-2256
NPI assigned
Feb 1, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2021

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 070121 NY Primary

Addresses

Primary practice location

505 Ellicott St
Buffalo, NY 14203-1547

Mailing address

155 N Main St
Liberty, NY 12754-1864

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
070121NYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Calm Seas Psychotherapy, LCSW,PLLC Clinical CurrentSince Nov 28, 2021 Accepting new patients
Mary Kathleen Martin Nurse Practitioner in Psychiatry, PLLC PastSince Sep 1, 2022 Accepting new patients

Locations

295 Main St
Rm 766
Buffalo, NY 14203
Phone (888) 975-2256

155 N Main St
Liberty, NY 12754
Phone (631) 831-2271

11700 Main Rd
Ste 1
Mattituck, NY 11952
Phone (631) 624-7839

28 N Country Rd
Ste 203
Mount Sinai, NY 11766
Phone (888) 975-2256

Organizations & group practices 2

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": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637366400000",
    "number": "1790822237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 N MAIN ST",
            "city": "LIBERTY",
            "state": "NY",
            "postal_code": "127541864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 ELLICOTT ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142031547",
            "telephone_number": "888-975-2256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSTON",
        "first_name": "JENNIFER",
        "middle_name": "L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-01",
        "last_updated": "2021-11-20",
        "certification_date": "2021-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "070121",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2021; 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.