Active NPI
Susan Eaccarino, LCSW
- Clinical Social Worker
- Tacoma, WA
National Provider Identifier
1023614716
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 10190
- Practice address
- 9040 Jackson Avenue
Tacoma, WA 98431-7324 - Phone
- (253) 968-2252
- NPI assigned
- Dec 8, 2020
- 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 | 10190 | CT | Primary |
Addresses
Primary practice location
9040 Jackson Avenue
Tacoma, WA 98431-7324
Mailing address
2817 Reilly St
Fort Bragg, NC 28310-7324
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 |
|---|---|---|---|
| 10190 | CT | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1607385600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692662400000",
"number": "1023614716",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2817 REILLY ST",
"city": "FORT BRAGG",
"state": "NC",
"postal_code": "283107324"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9040 JACKSON AVENUE",
"city": "TACOMA",
"state": "WA",
"postal_code": "984317324",
"telephone_number": "253-968-2252"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EACCARINO",
"first_name": "SUSAN",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-12-08",
"last_updated": "2023-08-22",
"certification_date": "2023-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CT",
"license": "10190",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.