Jacque Tara Washington, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

R080091 Issued in NY

Practice address

201 E. Green St
Ithaca, NY 14850-5421

Phone

(607) 274-6230

Fax

(607) 274-6316

NPI assigned

Feb 17, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1234828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1448841600000",
    "number": "1265671150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 E. GREEN ST",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148505421",
            "telephone_number": "607-274-6230",
            "fax_number": "607-274-6316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 E. GREEN ST",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148505421",
            "telephone_number": "607-274-6230",
            "fax_number": "607-274-6316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASHINGTON",
        "first_name": "JACQUE",
        "middle_name": "TARA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-02-17",
        "last_updated": "2015-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "075193-1",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "080091-1",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R080091",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lawrence Ward
• Devyn Faith Warner
• Sarah Jane Warner, OTR/L
• Warren Convenient Care Physicians
• Patricia Washburn, RN
• Michael Waters, M.D.
• Clinton Harold Wattenberg, RD
• Muhammad Ahmad Wattoo, MD
• Marnie S. Waxman, LCSW
• Nancy W Wayman, LCSW

• Clinical Social Worker in Ithaca, NY
• Providers in Ithaca, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2015; 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.