Active NPI
Jacqueline E Rose, LMSW
- School Social Worker
- North Tonawanda, NY
National Provider Identifier
1922383595
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Social Worker
- License
- 39487
- Practice address
- 789 Gilmore Ave
North Tonawanda, NY 14120-6743 - Phone
- (716) 807-3753
- Fax
- (716) 870-3751
- NPI assigned
- Oct 14, 2011
- Last updated
- Aug 14, 2024
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 088228 | NY | |
| School Social Worker | 1041S0200X | 39487 | NY | Primary |
Addresses
Primary practice location
789 Gilmore Ave
North Tonawanda, NY 14120-6743
Mailing address
789 Gilmore Ave
North Tonawanda, NY 14120
Phone (716) 807-3753
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01377162 | Medicaid | NY |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 088228 | NY | MD | Clinical Social Worker |
| 39487 | NY | MD | School Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shine Medical Providers PC | Past | Accepting new patients | |
| Uplift Behavioral Health PC | Clinical | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Psychiatry Physician
- Philadelphia, PA
- NPI 1538894050
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1318550400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723593600000",
"number": "1922383595",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "789 GILMORE AVE",
"city": "NORTH TONAWANDA",
"state": "NY",
"postal_code": "14120",
"telephone_number": "716-807-3753",
"fax_number": "716-870-3751"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "789 GILMORE AVE",
"city": "NORTH TONAWANDA",
"state": "NY",
"postal_code": "141206743",
"telephone_number": "716-807-3753",
"fax_number": "716-870-3751"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSE",
"first_name": "JACQUELINE",
"middle_name": "E",
"name_prefix": "Ms.",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-10-14",
"last_updated": "2024-08-14",
"certification_date": "2024-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "088228",
"primary": false
},
{
"code": "1041S0200X",
"taxonomy_group": "",
"desc": "Social Worker, School",
"state": "NY",
"license": "39487",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01377162",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in North Tonawanda, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.