Joan Tibaldi, LCSW, BCD

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW15600 Issued in FL

Practice address

612 Copperhead Cir
Saint Augustine, FL 32092-2733

Phone

(904) 679-4321

NPI assigned

Dec 26, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Mar 23, 2014 through Mar 23, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1167091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570752000000",
    "number": "1053476473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 COPPERHEAD CIR",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320922733",
            "telephone_number": "904-679-4321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 COPPERHEAD CIR",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320922733",
            "telephone_number": "904-679-4321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIBALDI",
        "first_name": "JOAN",
        "name_prefix": "Mrs.",
        "credential": "LCSW, BCD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-26",
        "last_updated": "2019-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R20522",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW15600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI PROVIDER #",
            "identifier": "37793",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Saint Augustine, FL
• Providers in Saint Augustine, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.