Blkjade. Mental Wellness, LLC.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

BLKJADE. MENTAL WELLNESS, LLC.

Practice address

2926 NE Flanders St # 3a
Portland, OR 97232-3259

Phone

(503) 208-8258

Fax

(503) 328-7780

NPI assigned

Aug 18, 2023

Last updated

Oct 5, 2023By 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

Roxanne Sheena Capparelli, LCSW, CADC-RNPI 1861893232

Title

Owner / Sole Member

Phone

(503) 208-8258

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

Practitioners 1

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.

• Roxanne S Capparelli, LCSW

  • Clinical Social Worker
  • Portland, OR
  • NPI 1861893232
  NPD Authorized official

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

{
    "created_epoch": "1692316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696464000000",
    "number": "1285418517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3519 NE 15TH AVE # 294",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972122356",
            "telephone_number": "503-208-8258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2926 NE FLANDERS ST # 3A",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972323259",
            "telephone_number": "503-208-8258",
            "fax_number": "503-328-7780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLKJADE. MENTAL WELLNESS, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-18",
        "last_updated": "2023-10-05",
        "certification_date": "2023-10-05",
        "status": "A",
        "authorized_official_last_name": "CAPPARELLI",
        "authorized_official_first_name": "ROXANNE",
        "authorized_official_middle_name": "SHEENA",
        "authorized_official_title_or_position": "OWNER / SOLE MEMBER",
        "authorized_official_telephone_number": "503-208-8258",
        "authorized_official_credential": "LCSW, CADC-R"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1861893232",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500822543",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bliss Lactation, LLC
• Annelise Bliss, MED, CCC-SLP
• Kya Bliss, LMT
• Laura Bliss
• Matthew Michael Bliziotes, MD
• Andrea Bloch
• Isaac Woods Bloch
• Pamela Jean Bloch
• Heather Block
• Matthew M Block, MA LPC

• Clinical Social Worker in Portland, OR
• Providers in Portland, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2023; 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.