Active NPI
Phyllis Jacobson Kram, LCSW
- Clinical Social Worker
- McLean, VA
National Provider Identifier
1164577474
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 0904000778
- Practice address
- 5910 Chesterbrook Rd
McLean, VA 22101-3348 - Phone
- (703) 536-1603
- NPI assigned
- Jan 24, 2007
- 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 | 0904000778 | VA | Primary |
Addresses
Primary practice location
5910 Chesterbrook Rd
McLean, VA 22101-3348
Mailing address
5910 Chesterbrook Rd
McLean, VA 22101-3348
Phone (703) 536-1603
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jan 1, 2016 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169596800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1197331200000",
"number": "1164577474",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5910 CHESTERBROOK RD",
"city": "MCLEAN",
"state": "VA",
"postal_code": "221013348",
"telephone_number": "703-536-1603"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5910 CHESTERBROOK RD",
"city": "MCLEAN",
"state": "VA",
"postal_code": "221013348",
"telephone_number": "703-536-1603"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBSON KRAM",
"first_name": "PHYLLIS",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-24",
"last_updated": "2007-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "VA",
"license": "0904000778",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McLean, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.