Kisha Parris Jacques, LCSW-C

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

14567 Issued in MD

Practice address

8662 Pulpit Harbour
Pasadena, MD 21122-2539

Phone

(718) 772-2261

NPI assigned

Jun 21, 2016

Last updated

Jun 21, 2016By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bon Ridge Wellness, LLC

  • Clinical Social Worker
  • Windsor Mill, MD
  • NPI 1922710995

  Mental Health

  Medicare reassignment NPD
• Bon Ridge Wellness, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Windsor Mill, MD
  • NPI 1043004575
  NPD (past)

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

{
    "created_epoch": "1466467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466467200000",
    "number": "1306296314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8662 PULPIT HARBOUR",
            "city": "PASADENA",
            "state": "MD",
            "postal_code": "211222539",
            "telephone_number": "718-772-2261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8662 PULPIT HARBOUR",
            "city": "PASADENA",
            "state": "MD",
            "postal_code": "211222539",
            "telephone_number": "718-772-2261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARRIS JACQUES",
        "first_name": "KISHA",
        "name_prefix": "Ms.",
        "credential": "LCSW-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-06-21",
        "last_updated": "2016-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MD",
            "license": "14567",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "14567",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pace RX LLC (Pace Wellness Pharmacy)
• Pace-RX, LLC (Pace Wellness Pharmacy)
• Anwaar Pace, HAD
• Salvador Papa, MD
• Maria Del Pilar Pardi, M.D.
• Partners in Care, Maryland
• Pasadena Eye Care, LLC
• Pasadena Foot and Ankle Center, LLC
• Pasadena Neck and Back Pain Center LLC
• Ami Patel

• Clinical Social Worker in Pasadena, MD
• Providers in Pasadena, MD by specialty
• Clinical Social Worker in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.