Active NPI
Jack L. Powell, LCSW-C
- Clinical Social Worker
- Cambridge, MD
National Provider Identifier
1104090547
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 08358
- Practice address
- 310 Gay St
Lower Level
Cambridge, MD 21613-1898 - Phone
- (410) 228-7714
- Fax
- (410) 228-8049
- NPI assigned
- Apr 16, 2008
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 08358 | MD | Primary |
Addresses
Primary practice location
310 Gay St
Lower Level
Cambridge, MD 21613-1898
Mailing address
310 Gay St
Lower Level
Cambridge, MD 21613-1898
Phone (410) 228-7714
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 |
|---|---|---|---|
| 08358 | MD | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Comptroller of Maryland Central Payroll Bureau | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Psychiatric Hospital Unit
- Catonsville, MD
- NPI 1962493403
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1208304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1266969600000",
"number": "1104090547",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "310 GAY ST",
"address_2": "LOWER LEVEL",
"city": "CAMBRIDGE",
"state": "MD",
"postal_code": "216131898",
"telephone_number": "410-228-7714",
"fax_number": "410-228-8049"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "310 GAY ST",
"address_2": "LOWER LEVEL",
"city": "CAMBRIDGE",
"state": "MD",
"postal_code": "216131898",
"telephone_number": "410-228-7714",
"fax_number": "410-228-8049"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POWELL",
"first_name": "JACK",
"middle_name": "L.",
"credential": "LCSW-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-04-16",
"last_updated": "2010-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MD",
"license": "08358",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cambridge, MD
- Potomac Ridge Behaviorial Health Eastern Shore
- Potomac Ridge Behaviorial Health Eastern Shore
- Potomac Ridge Behaviorial Health System Eastern Shore
- Potomac Ridge Behavorial Health Eastern Shore
- Potomac Ridge- Eastern Shore
- Lori Ruth Powley, LCSW-C
- Adebowale Prest, MD
- Lori Joy Price, LCPC
- Privia Medical Group, LLC
- Privia Medical Group, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 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.