Larita Jackson Lee, MSW, LSW, ACSW, DCSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

SW000401E Issued in PA

Practice address

3623 Wallace St
Phila, PA 19104-1932

Phone

(215) 301-1384

NPI assigned

Mar 21, 2012

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 names 1

• Ms. Larita Jackson Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1332288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332288000000",
    "number": "1205101441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3623 WALLACE ST",
            "city": "PHILA",
            "state": "PA",
            "postal_code": "191041932",
            "telephone_number": "215-301-1384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3623 WALLACE ST",
            "city": "PHILA",
            "state": "PA",
            "postal_code": "191041932",
            "telephone_number": "215-301-1384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON LEE",
        "first_name": "LARITA",
        "name_prefix": "Ms.",
        "credential": "MSW, LSW, ACSW, DCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-03-21",
        "last_updated": "2012-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "PA",
            "license": "SW000401E",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LARITA",
            "last_name": "JACKSON",
            "prefix": "MS.",
            "credential": "MSW,LSW,ACSW,DCSW",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Social Worker in Phila, PA
• Providers in Phila, PA by specialty
• Social Worker in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2012; 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.