NPIMap

Organization Active NPI

Janice Martin Licensed Clinical Social Worker PC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Port Jefferson, NY
National Provider Identifier
1902427941
Registry record updated Apr 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
JANICE MARTIN LICENSED CLINICAL SOCIAL WORKER PC
Practice address
710 Main St
Port Jefferson, NY 11777-2278
Phone
(631) 680-7222
NPI assigned
Apr 30, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Janice M Martin, LCSWNPI 1336205350
Title
President
Phone
(631) 680-7222

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

710 Main St
Port Jefferson, NY 11777-2278

Mailing address

PO Box 433
Port Jefferson, NY 11777-0433
Phone (631) 680-7222

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210312000178 NY Part B Supplier - Clinic/Group Practice 6305252537 Receives reassigned benefits from 9 practitioners
Practice locations: Port Jefferson, NY

National Provider Directory

National Provider Directory

Locations

407 E Main St
Port Jefferson, NY 11777
Phone (631) 474-2934

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1588204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588204800000",
    "number": "1902427941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 433",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117770433",
            "telephone_number": "631-680-7222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 MAIN ST",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117772278",
            "telephone_number": "631-680-7222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JANICE MARTIN LICENSED CLINICAL SOCIAL WORKER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-30",
        "last_updated": "2020-04-30",
        "certification_date": "2020-04-30",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "JANICE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "631-680-7222",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.