Active NPI
Patricia Dejesus, LCSW
- Clinical Social Worker
- Crown Point, IN
National Provider Identifier
1871247882
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 34007603A
- Practice address
- 1170 Mary Ellen Dr
Crown Point, IN 46307-7511 - Phone
- (219) 614-8687
- NPI assigned
- Feb 8, 2022
- Sex
- Female
- Sole proprietor
- Yes
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 | 34007603A | IN | Primary |
Addresses
Primary practice location
1170 Mary Ellen Dr
Crown Point, IN 46307-7511
Mailing address
1170 Mary Ellen Dr
Crown Point, IN 46307-7511
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 4, 2026 through Mar 4, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34007603A | IN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1644278400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1644278400000",
"number": "1871247882",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1170 MARY ELLEN DR",
"city": "CROWN POINT",
"state": "IN",
"postal_code": "463077511"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1170 MARY ELLEN DR",
"city": "CROWN POINT",
"state": "IN",
"postal_code": "463077511",
"telephone_number": "219-614-8687"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEJESUS",
"first_name": "PATRICIA",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-02-08",
"last_updated": "2022-02-08",
"certification_date": "2022-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IN",
"license": "34007603A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Crown Point, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.