Active NPI
Jack A Plate, LCSW,LMFT
- Clinical Social Worker
- Racine, WI
National Provider Identifier
1053453340
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 698-123
- Practice address
- 4810 Northwestern Ave
Racine, WI 53406-1504 - Phone
- (262) 637-9984
- Fax
- (262) 637-9995
- NPI assigned
- Feb 13, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 698-123 | WI | Primary |
| Marriage & Family Therapist | 106H00000X | 209-124 | WI |
Addresses
Primary practice location
4810 Northwestern Ave
Racine, WI 53406-1504
Mailing address
4810 Northwestern Ave
Racine, WI 53406-1504
Phone (262) 637-9984
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39534500 | Medicaid | WI |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 698-123 | WI | MD | Clinical Social Worker |
| 209-124 | WI | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1285200000000",
"number": "1053453340",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4810 NORTHWESTERN AVE",
"city": "RACINE",
"state": "WI",
"postal_code": "534061504",
"telephone_number": "262-637-9984",
"fax_number": "262-637-9995"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4810 NORTHWESTERN AVE",
"city": "RACINE",
"state": "WI",
"postal_code": "534061504",
"telephone_number": "262-637-9984",
"fax_number": "262-637-9995"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PLATE",
"first_name": "JACK",
"middle_name": "A",
"credential": "LCSW,LMFT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-13",
"last_updated": "2010-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WI",
"license": "698-123",
"primary": true
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "WI",
"license": "209-124",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39534500",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Racine, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.