Jenifer L Gietek, LCSW – Clinical Social Worker

Key facts

NPI: 1821332115
Entity type: Individual (NPI type 1)
Primary specialty: Clinical Social Worker 1041C0700X
License: 008070 (CT)
Practice address: 129 Tolland Stage Rd Ste 2
Tolland, CT 06084-2343
Phone: (860) 863-4732
Fax: (860) 454-8775
NPI assigned: Nov 27, 2012
Sex: Female
Sole proprietor: No

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.

Jenifer L Gietek LCSW LLC Community/Behavioral Health Agency · South Glastonbury, CT · NPI 1689091308

Medicare reassignment NPD Authorized official CT

Medicare Care Compare profile

Specialty: Clinical Social Worker
Education: Other, 2009
Medicare assignment: Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

129 Tolland Stage Rd
Suite 3
Tolland, CT 06084-2343
Phone (860) 508-6633

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
I20121219000012	CT	Practitioner - Clinical Social Worker	8820240997	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
8070	CT	MD	Speech-Language Pathologist

Practice roles

Organization	Specialty	Status	New patients
Jenifer L Gietek LCSW LLC		Current since Nov 3, 2015	Accepting new patients

Locations

129 Tolland Stage Rd
Ste 3
Tolland, CT 06084
Phone (860) 508-6633

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Clinical Social Worker	1041C0700X		CT
Clinical Social Worker	1041C0700X	008070	CT	Yes

Addresses

Primary practice location

129 Tolland Stage Rd Ste 2
Tolland, CT 06084-2343

Mailing address

PO Box 128
Suite 4
Tolland, CT 06084-0128
Phone (860) 508-6633

Other practice location 1

21 Bread and Milk St Fl 1
Coventry, CT 06238-1012
Phone (860) 508-6633

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 1, 2021.

{
    "created_epoch": "1353974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630454400000",
    "number": "1821332115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 128",
            "address_2": "SUITE 4",
            "city": "TOLLAND",
            "state": "CT",
            "postal_code": "060840128",
            "telephone_number": "860-508-6633",
            "fax_number": "860-454-8775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 TOLLAND STAGE RD STE 2",
            "city": "TOLLAND",
            "state": "CT",
            "postal_code": "060842343",
            "telephone_number": "860-863-4732",
            "fax_number": "860-454-8775"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "21 Bread and Milk St Fl 1",
            "address_purpose": "LOCATION",
            "city": "Coventry",
            "state": "CT",
            "postal_code": "062381012",
            "country_code": "US",
            "telephone_number": "860-508-6633",
            "fax_number": "860-454-8775",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GIETEK",
        "first_name": "JENIFER",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-27",
        "last_updated": "2021-09-01",
        "certification_date": "2021-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "008070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tolland, CT

All providers in Tolland, CT · Clinical 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 Sep 1, 2021. 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).
Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.