Laura Jo Vacheresse, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0000006584 Issued in TN

Practice address

4798 New Highway 68
Madisonville, TN 37354

Phone

(423) 442-2622

NPI assigned

Jan 27, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Laura Jo Aldridge Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1422316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539216000000",
    "number": "1144610304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 278",
            "city": "MADISONVILLE",
            "state": "TN",
            "postal_code": "373540278",
            "telephone_number": "423-442-2622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4798 NEW HIGHWAY 68",
            "city": "MADISONVILLE",
            "state": "TN",
            "postal_code": "37354",
            "telephone_number": "423-442-2622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VACHERESSE",
        "first_name": "LAURA",
        "middle_name": "JO",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-01-27",
        "last_updated": "2018-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041S0200X",
            "taxonomy_group": "",
            "desc": "Social Worker, School",
            "state": "TN",
            "license": "000623914",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TN",
            "license": "0000006584",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAURA",
            "last_name": "ALDRIDGE",
            "middle_name": "JO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Clinical Social Worker in Madisonville, TN
• Providers in Madisonville, TN by specialty
• Clinical Social Worker in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.