Active NPI
Jessica Roeder
- Clinical Social Worker
- Elizabethtown, NY
National Provider Identifier
1871971176
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 083744-1
- Practice address
- 7513 Court Street
Elizabethtown, NY 12932-0008 - Phone
- (518) 873-3670
- Fax
- (518) 873-3777
- NPI assigned
- May 7, 2015
- 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 | 083744-1 | NY | Primary |
Addresses
Primary practice location
7513 Court Street
Elizabethtown, NY 12932-0008
Mailing address
PO Box 8
7513 Court Street
Elizabethtown, NY 12932-0008
Phone (518) 873-3670
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 |
|---|---|---|---|
| 083744-1 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1430956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456790400000",
"number": "1871971176",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8",
"address_2": "7513 COURT STREET",
"city": "ELIZABETHTOWN",
"state": "NY",
"postal_code": "129320008",
"telephone_number": "518-873-3670",
"fax_number": "518-873-3777"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7513 COURT STREET",
"city": "ELIZABETHTOWN",
"state": "NY",
"postal_code": "129320008",
"telephone_number": "518-873-3670",
"fax_number": "518-873-3777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROEDER",
"first_name": "JESSICA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-05-07",
"last_updated": "2016-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "083744-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elizabethtown, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.