Active NPI
Vivian Keller Tate, LCSW
- Clinical Social Worker
- Gulfport, MS
National Provider Identifier
1063531663
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- C2058
- Practice address
- 1403 43Rd Avenue
Gulfport, MS 39501 - Phone
- (228) 897-7730
- Fax
- (228) 575-0886
- NPI assigned
- Mar 28, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 2561 | MS | |
| Clinical Social Worker | 1041C0700X | C2058 | MS | Primary |
Addresses
Primary practice location
1403 43Rd Avenue
Gulfport, MS 39501
Mailing address
P.O. Box 7827
Gulfport, MS 39506
Phone (228) 897-7730
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 |
|---|---|---|---|
| 2561 | MS | MD | Clinical Social Worker |
| C2058 | MS | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175040000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1285113600000",
"number": "1063531663",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 7827",
"city": "GULFPORT",
"state": "MS",
"postal_code": "39506",
"telephone_number": "228-897-7730",
"fax_number": "228-575-0886"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1403 43RD AVENUE",
"city": "GULFPORT",
"state": "MS",
"postal_code": "39501",
"telephone_number": "228-897-7730",
"fax_number": "228-575-0886"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TATE",
"first_name": "VIVIAN",
"middle_name": "KELLER",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-28",
"last_updated": "2010-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MS",
"license": "2561",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MS",
"license": "C2058",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gulfport, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 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.