NPIMap

Organization Active NPI

Jewish Family Service of Tidewater, Incorporated

  • Clinical Social Worker
  • Virginia Beach, VA
National Provider Identifier
1124088638
Registry record updated Apr 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
JEWISH FAMILY SERVICE OF TIDEWATER, INCORPORATED
Practice address
260 Grayson Rd Ste 200
Virginia Beach, VA 23462-4345
Phone
(757) 459-4640
Fax
(757) 459-4643
NPI assigned
Mar 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2023

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

Authorized official

Name
Debra Friedman Mayer, LCSWNPI 1699735308
Title
Clinical Director
Phone
(757) 459-4640

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

260 Grayson Rd Ste 200
Virginia Beach, VA 23462-4345

Mailing address

5000 Corporate Woods Dr Ste 400
Virginia Beach, VA 23462-4429
Phone (757) 459-4640

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040816001334 VA Part B Supplier - Clinic/Group Practice 2365356169 Receives reassigned benefits from 8 practitioners
Practice locations: Virginia Beach, VA

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

260 Grayson Rd
Ste 200
Virginia Beach, VA 23462
Phone (757) 459-4640

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1143417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680825600000",
    "number": "1124088638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 CORPORATE WOODS DR STE 400",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234624429",
            "telephone_number": "757-459-4640",
            "fax_number": "757-459-4643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 GRAYSON RD STE 200",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234624345",
            "telephone_number": "757-459-4640",
            "fax_number": "757-459-4643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEWISH FAMILY SERVICE OF TIDEWATER, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-27",
        "last_updated": "2023-04-07",
        "certification_date": "2023-04-07",
        "status": "A",
        "authorized_official_last_name": "MAYER",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "FRIEDMAN",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "757-459-4640",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Virginia Beach, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.