Jillian Fenton LLC

Key facts

NPI

1992952402

Entity type

Organization (NPI type 2)

Primary specialty

Clinical Social Worker 1041C0700X

License

01636 (RI)

Legal business name

JILLIAN FENTON LLC

Practice address

11 King Charles Dr
Suite a
Portsmouth, RI 02871-1364

Phone

(401) 683-2555

NPI assigned

Aug 26, 2008

Organization subpart

No

Authorized official

Name

Ms. Jillian Fenton, MSW, LICSW NPI 1083665921

Title

Clinical Social Worker

Phone

(401) 683-2555

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

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jillian Fenton, MSW, LICSW Clinical Social Worker · Portsmouth, RI · NPI 1083665921
  Medicare reassignment NPD Authorized official CLINICAL · RI

Medicare participation

Medicare fee-for-service enrollment

Enrolled in RI

Medicare enrollment records

National Provider Directory

Locations

Specialties & licenses

Addresses

Other names

• Jillian Fenton, LICSW Doing business as

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 26, 2008.

{
    "created_epoch": "1219708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219708800000",
    "number": "1992952402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 KING CHARLES DR",
            "address_2": "SUITE A",
            "city": "PORTSMOUTH",
            "state": "RI",
            "postal_code": "028711364",
            "telephone_number": "401-683-2555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 KING CHARLES DR",
            "address_2": "SUITE A",
            "city": "PORTSMOUTH",
            "state": "RI",
            "postal_code": "028711364",
            "telephone_number": "401-683-2555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JILLIAN FENTON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-26",
        "last_updated": "2008-08-26",
        "status": "A",
        "authorized_official_last_name": "FENTON",
        "authorized_official_first_name": "JILLIAN",
        "authorized_official_title_or_position": "CLINICAL SOCIAL WORKER",
        "authorized_official_telephone_number": "401-683-2555",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MSW, LICSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "RI",
            "license": "01636",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jillian Fenton, LICSW",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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