Regina A Blackwolf, MSW, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LW60083962 Issued in WA

Practice address

12812 3Rd Ave SE Ste a
Everett, WA 98208-6455

Phone

(206) 375-7657

Fax

(206) 319-5325

NPI assigned

Jan 19, 2007

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

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

Specialty

Clinical Social Worker

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

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 and National Provider Directory roles.

• Approaching Authenticity, PLLC

  • Community/Behavioral Health Agency
  • Everett, WA
  • NPI 1811326804
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677801600000",
    "number": "1184777252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12812 3RD AVE SE STE A",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982086455",
            "telephone_number": "206-375-7657",
            "fax_number": "206-319-5325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12812 3RD AVE SE STE A",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982086455",
            "telephone_number": "206-375-7657",
            "fax_number": "206-319-5325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKWOLF",
        "first_name": "REGINA",
        "middle_name": "A",
        "credential": "MSW, LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-19",
        "last_updated": "2023-03-03",
        "certification_date": "2023-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CP00005962",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW60083962",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Blacke, MD
• Denise Blackwell, PT
• Jeffrey S Blackwell
• Madysen Grace Blackwell
• Cryss Blackwolf
• Debbie Blair
• Renya Blaise
• Earlene Blake
• Lindsey Christine Blake, MSW, MHP, LSWAIC
• Amy Blanchard, RN

• Clinical Social Worker in Everett, WA
• Providers in Everett, 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 Mar 3, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.