Active NPI
Jack Vallejo, MSW, LCSWC
- School Social Worker
- Eldersburg, MD
National Provider Identifier
1346626181
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Social Worker
- License
- 07259
- Practice address
- 1311 Londontown Blvd
Suite # 130a
Eldersburg, MD 21784-6454 - Phone
- (410) 356-9200
- Fax
- (443) 200-0267
- NPI assigned
- Aug 4, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Social Worker | 1041S0200X | 07259 | MD | Primary |
Addresses
Primary practice location
1311 Londontown Blvd
Suite # 130a
Eldersburg, MD 21784-6454
Mailing address
PO Box 1229
Sykesville, MD 21784-1229
Phone (410) 356-9200
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 07259 | MD | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1438646400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1438646400000",
"number": "1346626181",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1229",
"city": "SYKESVILLE",
"state": "MD",
"postal_code": "217841229",
"telephone_number": "410-356-9200",
"fax_number": "443-200-0267"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1311 LONDONTOWN BLVD",
"address_2": "SUITE # 130A",
"city": "ELDERSBURG",
"state": "MD",
"postal_code": "217846454",
"telephone_number": "410-356-9200",
"fax_number": "443-200-0267"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VALLEJO",
"first_name": "JACK",
"credential": "MSW, LCSWC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-08-04",
"last_updated": "2015-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "1041S0200X",
"taxonomy_group": "",
"desc": "Social Worker, School",
"state": "MD",
"license": "07259",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eldersburg, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.