Milicent Ann Mack, LMSW
Individual provider Active NPI Social Worker · Triangle, VA
NPI 1316628829 · NPPES record last updated Jul 27, 2023
Key facts
- NPI
- 1316628829
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- 0903003824 (VA)
- Practice address
- 5009 Potomac Highlands Cir
Triangle, VA 22172-1780 - Phone
- (908) 662-4844
- NPI assigned
- Jul 27, 2023
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 0906013351 | VA | |
| Social Worker | 104100000X | 0903003824 | VA | Yes |
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
Other providers in Triangle, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 27, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.