Active NPI
Elizabeth Hansen, LCSW
- Clinical Social Worker
- Belleville, IL
National Provider Identifier
1013105600
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- CSW003804
- Practice address
- 1624 Carlyle Ave # 503
Belleville, IL 62221-4558 - Phone
- (404) 723-9983
- NPI assigned
- Oct 9, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 | CSW003804 | GA | Primary |
Addresses
Primary practice location
1624 Carlyle Ave # 503
Belleville, IL 62221-4558
Mailing address
1624 Carlyle Ave # 503
Belleville, IL 62221-4558
Phone (404) 723-9983
Other practice location 1
675 Seminole Ave NE
Suite 304
Atlanta, GA 30307-3408
Phone (404) 723-9983
Other names 1
- Elizabeth Gartner Gould
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 |
|---|---|---|---|
| CSW003804 | GA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Teladoc Health Medical Group, P.a. | Clinical | Current | Accepting new patients |
Interoperability endpoints
- elizabethhansen@tdh.allscriptsdirect.net
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1191888000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609977600000",
"number": "1013105600",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1624 CARLYLE AVE # 503",
"city": "BELLEVILLE",
"state": "IL",
"postal_code": "622214558",
"telephone_number": "404-723-9983"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1624 CARLYLE AVE # 503",
"city": "BELLEVILLE",
"state": "IL",
"postal_code": "622214558",
"telephone_number": "404-723-9983"
}
],
"practiceLocations": [
{
"address_1": "675 Seminole Ave NE",
"address_2": "Suite 304",
"address_purpose": "LOCATION",
"city": "Atlanta",
"state": "GA",
"postal_code": "303073408",
"country_code": "US",
"telephone_number": "404-723-9983",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HANSEN",
"first_name": "ELIZABETH",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-10-09",
"last_updated": "2021-01-07",
"certification_date": "2021-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "GA",
"license": "CSW003804",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "ELIZABETH",
"last_name": "GOULD",
"middle_name": "GARTNER",
"credential": "LCSW",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Belleville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.