Carol G Fortune LCSW PA

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

CAROL G FORTUNE LCSW PA

Practice address

1522 Golden Ridge Dr
The Villages, FL 32162-6765

Phone

(352) 638-2264

Fax

(352) 350-7244

NPI assigned

Feb 25, 2019

Last updated

Mar 4, 2019By 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. Carol G Fortune, LCSWNPI 1578673083

Title

Owner

Phone

(352) 638-2264

Specialties & licenses 1

Addresses

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.

• Carol G Fortune, LICSW

  • Clinical Social Worker
  • Lady Lake, FL
  • NPI 1578673083
  Authorized official Same address or phone

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

{
    "created_epoch": "1551052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551657600000",
    "number": "1295292472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1522 GOLDEN RIDGE DR",
            "city": "THE VILLAGES",
            "state": "FL",
            "postal_code": "321626765",
            "telephone_number": "352-638-2264",
            "fax_number": "352-350-7244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1522 GOLDEN RIDGE DR",
            "city": "THE VILLAGES",
            "state": "FL",
            "postal_code": "321626765",
            "telephone_number": "352-638-2264",
            "fax_number": "352-350-7244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROL G FORTUNE LCSW PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-25",
        "last_updated": "2019-03-04",
        "status": "A",
        "authorized_official_last_name": "FORTUNE",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "352-638-2264",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in The Villages, FL
• Providers in The Villages, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2019; 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.