Active NPI
Jacqueline M Eddy, LICSW
- Clinical Social Worker
- Rutland, VT
National Provider Identifier
1114570371
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 0890134209
- Practice address
- 78 S Main St
Rutland, VT 05701-4594 - Phone
- (802) 775-8224
- Fax
- (802) 747-7699
- NPI assigned
- Jul 17, 2019
- Last updated
- Jul 17, 2019
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 0890134209 | VT | Primary |
Addresses
Primary practice location
78 S Main St
Rutland, VT 05701-4594
Mailing address
78 S Main St
Rutland, VT 05701-4594
Phone (802) 775-8224
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 3, 2024 through Mar 3, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0890134209 | VT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1563321600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1563321600000",
"number": "1114570371",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "78 S MAIN ST",
"city": "RUTLAND",
"state": "VT",
"postal_code": "057014594",
"telephone_number": "802-775-8224",
"fax_number": "802-747-7699"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "78 S MAIN ST",
"city": "RUTLAND",
"state": "VT",
"postal_code": "057014594",
"telephone_number": "802-775-8224",
"fax_number": "802-747-7699"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDDY",
"first_name": "JACQUELINE",
"middle_name": "M",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-07-17",
"last_updated": "2019-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "VT",
"license": "0890134209",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rutland, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.