Individual provider Active NPI

Jessica Diana Simmons, LMSW

  • Social Worker
  • Hauppauge, NY
National Provider Identifier
1962981613
Registry record updated Jul 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
126704-01 Issued in NY
Practice address
888 Veterans Hwy Ste 310
Hauppauge, NY 11788-2940
Phone
(718) 830-9274
NPI assigned
Aug 13, 2018
Last updated
Jul 15, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 15, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator 171M00000X
Social Worker 104100000X 126704-01 NY Primary

Addresses

Primary practice location

888 Veterans Hwy Ste 310
Hauppauge, NY 11788-2940

Mailing address

888 Veterans Hwy Ste 310
Hauppauge, NY 11788-2940

Other practice location 1

4024 Amboy Rd
Staten Island, NY 10308-2409
Phone (718) 984-9022

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

LicenseStateTypeSpecialty
126704-01NYMDSocial Worker

NPI Registry JSON

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

{
    "created_epoch": "1534118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752537600000",
    "number": "1962981613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "888 VETERANS HWY STE 310",
            "city": "HAUPPAUGE",
            "state": "NY",
            "postal_code": "117882940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "888 VETERANS HWY STE 310",
            "city": "HAUPPAUGE",
            "state": "NY",
            "postal_code": "117882940",
            "telephone_number": "718-830-9274"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4024 Amboy Rd",
            "address_purpose": "LOCATION",
            "city": "Staten Island",
            "state": "NY",
            "postal_code": "103082409",
            "country_code": "US",
            "telephone_number": "718-984-9022",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIMMONS",
        "first_name": "JESSICA",
        "middle_name": "DIANA",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-13",
        "last_updated": "2025-07-15",
        "certification_date": "2025-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "126704-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hauppauge, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.