Active NPI
Jeanne Carlisle
- Clinical Social Worker
- Modesto, CA
National Provider Identifier
1346870078
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW25680
- Practice address
- 4368 Spyres Way
Modesto, CA 95356-9259 - Phone
- (209) 578-6300
- NPI assigned
- Jan 22, 2020
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCSW25680 | CA | Primary |
Addresses
Primary practice location
4368 Spyres Way
Modesto, CA 95356-9259
Mailing address
4368 Spyres Way
Modesto, CA 95356-9259
Phone (209) 578-6300
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | hospiceheart.org | Direct |
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 |
|---|---|---|---|
| LCSW25680 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1579651200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1579651200000",
"number": "1346870078",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4368 SPYRES WAY",
"city": "MODESTO",
"state": "CA",
"postal_code": "953569259",
"telephone_number": "209-578-6300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4368 SPYRES WAY",
"city": "MODESTO",
"state": "CA",
"postal_code": "953569259",
"telephone_number": "209-578-6300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLISLE",
"first_name": "JEANNE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-01-22",
"last_updated": "2020-01-22",
"certification_date": "2020-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCSW25680",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "hospiceheart.org",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "organization email",
"address_1": "4368 Spyres Way",
"city": "Modesto",
"state": "CA",
"country_code": "US",
"postal_code": "953569259",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.