Individual provider Active NPI

Chrissy Justilien

  • Clinical Social Worker
  • Lauderdale Lakes, FL
National Provider Identifier
1346681715
Registry record updated Mar 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SW14663 Issued in FL
Practice address
4700 N State Road 7
Lauderdale Lakes, FL 33319-5800
Phone
(954) 735-4530
NPI assigned
Jul 12, 2013
Last updated
Mar 14, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU
Clinical Social Worker 1041C0700X SW14663 FL Primary

Addresses

Primary practice location

4700 N State Road 7
Lauderdale Lakes, FL 33319-5800

Mailing address

4740 N State Road 7
201
Lauderdale Lakes, FL 33319-5839

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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

Enrollment IDStateProvider typePAC IDDetails
I20220915000745 FL Practitioner - Clinical Social Worker 0648527259 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Doctor on Demand Professionals P CGroup PAC ID 9436464567, 113 clinicians

Practice addresses (Care Compare)

1201 Hays St
Tallahassee, FL 32301-2699
Phone (800) 997-6196

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SW14663FLMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Doctor on Demand Professionals P C CurrentSince Jun 14, 2022 Accepting new patients
Henderson Behavioral Health, Inc. PastSince Aug 29, 2017 Accepting new patients

Locations

1 California St
Ste 2300
San Francisco, CA 94111
Phone (800) 929-0926

1201 Hays St
Tallahassee, FL 32301
Phone (855) 522-7233

Interoperability endpoints

  • Direct secure messaging: chrissy.justilien.1@30520.direct.athenahealth.com

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1373587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647216000000",
    "number": "1346681715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4740 N STATE ROAD 7",
            "address_2": "201",
            "city": "LAUDERDALE LAKES",
            "state": "FL",
            "postal_code": "333195839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 N STATE ROAD 7",
            "city": "LAUDERDALE LAKES",
            "state": "FL",
            "postal_code": "333195800",
            "telephone_number": "954-735-4530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUSTILIEN",
        "first_name": "CHRISSY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-12",
        "last_updated": "2022-03-14",
        "certification_date": "2022-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW14663",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lauderdale Lakes, FL

Sources for this page

Verify at the official NPI Registry.