Justine Marie Ivy, MSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LW60334018 Issued in WA

Practice address

2641 242ND PL SE
Bothell, WA 98021-6508

Phone

(206) 229-4056

NPI assigned

Oct 14, 2019

Last updated

Oct 14, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Mindful Therapy Group PC

  dba Mindful Therapy Group

  • Clinical Social Worker
  • Mountlake Terrace, WA
  • NPI 1316238678
  Medicare reassignment NPD

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

{
    "created_epoch": "1571011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571011200000",
    "number": "1174165922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2641 242ND PL SE",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980216508",
            "telephone_number": "206-229-4056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2641 242ND PL SE",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980216508",
            "telephone_number": "206-229-4056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVY",
        "first_name": "JUSTINE",
        "middle_name": "MARIE",
        "credential": "MSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-10-14",
        "last_updated": "2019-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW60334018",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA LICSW PROVIDER NUMBER",
            "identifier": "LW60334018",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lena Ismail
• Claire Israel, D.D.S.
• Ziza R Israel
• Lisa Marie Ivanjack, MD
• John C Ive, DDS, MSD, PS
• Jayasri Iyer, M.D
• Brittany Jackson
• Diane M Jackson
• John L Jackson, PT, DPT, ATC
• Kamelya Jackson

• Clinical Social Worker in Bothell, WA
• Providers in Bothell, WA by specialty
• Clinical Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.