Active NPI
Milicent Ann Mack, LMSW
- Social Worker
- Triangle, VA
National Provider Identifier
1316628829
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 0903003824
- Practice address
- 5009 Potomac Highlands Cir
Triangle, VA 22172-1780 - Phone
- (908) 662-4844
- NPI assigned
- Jul 27, 2023
- Last updated
- Jul 27, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 0903003824 | VA | Primary |
| Clinical Social Worker | 1041C0700X | 0906013351 | VA |
Addresses
Primary practice location
5009 Potomac Highlands Cir
Triangle, VA 22172-1780
Mailing address
5009 Potomac Highlands Cir
Triangle, VA 22172-1780
Phone (908) 662-4844
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0903003824 | VA | MD | Social Worker |
| 0906013351 | VA | MD | Clinical Social Worker |
Interoperability endpoints
- potomacshoresmentalhealth&wellnesscente.millicentmackf@154927.advancedmd-direct.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1690416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690416000000",
"number": "1316628829",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5009 POTOMAC HIGHLANDS CIR",
"city": "TRIANGLE",
"state": "VA",
"postal_code": "221721780",
"telephone_number": "908-662-4844"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5009 POTOMAC HIGHLANDS CIR",
"city": "TRIANGLE",
"state": "VA",
"postal_code": "221721780",
"telephone_number": "908-662-4844"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACK",
"first_name": "MILICENT",
"middle_name": "ANN",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-07-27",
"last_updated": "2023-07-27",
"certification_date": "2023-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "VA",
"license": "0903003824",
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "VA",
"license": "0906013351",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Triangle, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 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.