Active NPI
Jaqueline Rivas
- Social Worker
- Fort Worth, TX
National Provider Identifier
1104169465
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 107429
- Practice address
- 4928 Navajo Way
Fort Worth, TX 76137-5151 - Phone
- (949) 929-4249
- NPI assigned
- Apr 4, 2013
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Social Worker | 104100000X | 107429 | TX | Primary |
Addresses
Primary practice location
4928 Navajo Way
Fort Worth, TX 76137-5151
Mailing address
4928 Navajo Way
Fort Worth, TX 76137-5151
Phone (949) 929-4249
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 |
|---|---|---|---|
| 107429 | TX | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1365033600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706140800000",
"number": "1104169465",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4928 NAVAJO WAY",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761375151",
"telephone_number": "949-929-4249"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4928 NAVAJO WAY",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761375151",
"telephone_number": "949-929-4249"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIVAS",
"first_name": "JAQUELINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-04-04",
"last_updated": "2024-01-25",
"certification_date": "2024-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "TX",
"license": "107429",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.