Active NPI
Jacqueline M Tisdale, MA
- Clinical Social Worker
- Fall River, MA
National Provider Identifier
1174764955
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 178 Pine St
Fall River, MA 02720-2312 - Phone
- (781) 437-1323
- NPI assigned
- Mar 9, 2009
- Sex
- Female
- Sole proprietor
- No
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 | Primary |
Addresses
Primary practice location
178 Pine St
Fall River, MA 02720-2312
Mailing address
1 Tupperware Dr
North Smithfield, RI 02896-6815
Phone (781) 437-1323
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 685661 | Other | MA | TUFTS |
| 1312677 | Medicaid | MA |
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)
- Not enrolled
- Credentials
- Master of Arts
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1236556800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1236556800000",
"number": "1174764955",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 TUPPERWARE DR",
"city": "NORTH SMITHFIELD",
"state": "RI",
"postal_code": "028966815",
"telephone_number": "781-437-1323"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "178 PINE ST",
"city": "FALL RIVER",
"state": "MA",
"postal_code": "027202312",
"telephone_number": "781-437-1323"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TISDALE",
"first_name": "JACQUELINE",
"middle_name": "M",
"credential": "MA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-03-09",
"last_updated": "2009-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS",
"identifier": "685661",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1312677",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fall River, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.