Active NPI
Tessa Mattie
- Social Worker
- San Diego, CA
National Provider Identifier
1063782787
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 21480187
- Practice address
- 3020 Childrens Way
San Diego, CA 92123-4223 - Phone
- (858) 966-1700
- NPI assigned
- Jan 11, 2012
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | ASW 24231 | CA | |
| Social Worker | 104100000X | 21480187 | CA | Primary |
Addresses
Primary practice location
3020 Childrens Way
San Diego, CA 92123-4223
Mailing address
1813 Bacon St
San Diego, CA 92107-3003
Phone (619) 665-1546
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 |
|---|---|---|---|
| ASW 24231 | CA | MD | Mental Health Counselor |
| 21480187 | CA | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1326240000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350345600000",
"number": "1063782787",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1813 BACON ST",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921073003",
"telephone_number": "619-665-1546"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3020 CHILDRENS WAY",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921234223",
"telephone_number": "858-966-1700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATTIE",
"first_name": "TESSA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-01-11",
"last_updated": "2012-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "ASW 24231",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "CA",
"license": "21480187",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.