NPIMap

Individual provider Active NPI

Angell Love-Jackson

  • Clinical Social Worker
  • Detroit, MI
National Provider Identifier
1164832200
Registry record updated Apr 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801072692 Issued in MI
Practice address
20100 Greenfield Rd
Detroit, MI 48235-1803
Phone
(313) 342-2699
NPI assigned
Apr 29, 2014
Last updated
Apr 29, 2014By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 29, 2014

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 6801072692 MI Primary

Addresses

Primary practice location

20100 Greenfield Rd
Detroit, MI 48235-1803

Mailing address

15139 Glastonbury Ave
Detroit, MI 48223-3602
Phone (313) 835-1541

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Ennis Center for Children, Inc Past Accepting new patients
CNS Healthcare PastSince Jun 1, 2020 Accepting new patients

Organizations & group practices 2

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": "1398729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398729600000",
    "number": "1164832200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15139 GLASTONBURY AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482233602",
            "telephone_number": "313-835-1541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20100 GREENFIELD RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482351803",
            "telephone_number": "313-342-2699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOVE-JACKSON",
        "first_name": "ANGELL",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-29",
        "last_updated": "2014-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801072692",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2014; 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.