Individual provider Active NPI

Marilyn Nicole Adams, LCSW

  • Clinical Social Worker
  • Arlington, TX
National Provider Identifier
1124610605
Registry record updated Apr 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
66735 Issued in TX
Practice address
1700 Covemeadow Dr
Arlington, TX 76012-5407
Phone
(972) 559-9227
NPI assigned
Feb 6, 2021
Last updated
Apr 27, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2021

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 66735 TX Primary

Addresses

Primary practice location

1700 Covemeadow Dr
Arlington, TX 76012-5407

Mailing address

1906 Fairlawn LN Unit B
Austin, TX 78704-3622
Phone (512) 363-6956

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230626000729 TX Practitioner - Clinical Social Worker 3577921451 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
66735TXMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Austin Travis County Mental Health and Mental Retardation Center CurrentSince May 30, 2023 Accepting new patients
Austin Travis County Mental Health and Mental Retardation Center Clinical CurrentSince May 30, 2023 Accepting new patients
Beyond the Gray Sky LLC CurrentSince May 16, 2021 Accepting new patients

Locations

1430 Collier St
Austin, TX 78704
Phone (512) 427-4357

1717 W 10th St
Austin, TX 78703
Phone (512) 472-3142

5015 S Interstate 35
Austin, TX 78744
Phone (512) 703-1392

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1612569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619481600000",
    "number": "1124610605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1906 FAIRLAWN LN UNIT B",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787043622",
            "telephone_number": "512-363-6956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 COVEMEADOW DR",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760125407",
            "telephone_number": "972-559-9227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADAMS",
        "first_name": "MARILYN",
        "middle_name": "NICOLE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-06",
        "last_updated": "2021-04-27",
        "certification_date": "2021-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "66735",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Arlington, TX

Sources for this page

Verify at the official NPI Registry.