Active NPI
Jeremiah E. Jensen, LCSW
- Clinical Social Worker
- Kingman, AZ
National Provider Identifier
1942448840
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LMSW12180
- Practice address
- 1726 Beverly Ave
Kingman VA Cboc
Kingman, AZ 86401 - Phone
- (928) 692-0080
- NPI assigned
- Jan 30, 2009
- Sex
- Male
- 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 | LMSW12180 | AZ | Primary |
Addresses
Primary practice location
1726 Beverly Ave
Kingman VA Cboc
Kingman, AZ 86401
Mailing address
PO Box 422
Yucca, AZ 86438-0422
Phone (928) 897-5744
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 |
|---|---|---|---|
| LMSW12180 | AZ | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1233273600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1233273600000",
"number": "1942448840",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 422",
"city": "YUCCA",
"state": "AZ",
"postal_code": "864380422",
"telephone_number": "928-897-5744"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1726 BEVERLY AVE",
"address_2": "KINGMAN VA CBOC",
"city": "KINGMAN",
"state": "AZ",
"postal_code": "86401",
"telephone_number": "928-692-0080"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENSEN",
"first_name": "JEREMIAH",
"middle_name": "E.",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-01-30",
"last_updated": "2009-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "AZ",
"license": "LMSW12180",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kingman, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.