Individual provider Active NPI

Carol Sgambellone, LISW-S

  • Clinical Social Worker
  • Mansfield, OH
National Provider Identifier
1093062150
Registry record updated Aug 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
I 0009462 Issued in OH
Practice address
151 Marion Ave
Mansfield, OH 44903-2223
Phone
(419) 774-9969
Fax
(419) 756-5642
NPI assigned
Aug 8, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X I 0009462 OH Primary

Addresses

Primary practice location

151 Marion Ave
Mansfield, OH 44903-2223

Mailing address

151 Marion Ave
Mansfield, OH 44903-2223
Phone (419) 774-9969

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

LicenseStateTypeSpecialty
I 0009462OHMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1344384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344384000000",
    "number": "1093062150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 MARION AVE",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449032223",
            "telephone_number": "419-774-9969",
            "fax_number": "419-756-5642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 MARION AVE",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449032223",
            "telephone_number": "419-774-9969",
            "fax_number": "419-756-5642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SGAMBELLONE",
        "first_name": "CAROL",
        "credential": "LISW-S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-08",
        "last_updated": "2012-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I 0009462",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mansfield, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 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.

Verify at the official NPI Registry.