The Fifth Season Center for Loss Grief and Transition

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

1305 Issued in SC

Legal business name

THE FIFTH SEASON CENTER FOR LOSS GRIEF AND TRANSITION

Practice address

111 Mills Ave
Greenville, SC 29605-4017

Phone

(864) 241-8222

Fax

(864) 241-8222

NPI assigned

Jun 30, 2011

Last updated

Sep 6, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Pattie S Broderick, LISWNPI 1174804090

Title

Executive Director

Phone

(864) 404-5070

Specialties & licenses 2

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Pattie S Broderick, LISW, CP/AP

  • Clinical Social Worker
  • Greenville, SC
  • NPI 1174804090
  NPD (past) Authorized official
• Dianne H McMahan, MED, MDIV, LPC

  • Mental Health Counselor
  • Greenville, SC
  • NPI 1477834117
  NPD (past)

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

{
    "created_epoch": "1309392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315267200000",
    "number": "1245527001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 MILLS AVE",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054017",
            "telephone_number": "864-241-8222",
            "fax_number": "864-241-8222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 MILLS AVE",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054017",
            "telephone_number": "864-241-8222",
            "fax_number": "864-241-8222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE FIFTH SEASON CENTER FOR LOSS GRIEF AND TRANSITION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-30",
        "last_updated": "2011-09-06",
        "status": "A",
        "authorized_official_last_name": "BRODERICK",
        "authorized_official_first_name": "PATTIE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "864-404-5070",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LISW"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "SC",
            "license": "5150",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "SC",
            "license": "1305",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Greenville, SC
• Providers in Greenville, SC by specialty
• Clinical Social Worker in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2011; 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.