NPIMap

Individual provider Active NPI

Diane Jackson, LCSW

  • Clinical Social Worker
  • Richmond, VA
National Provider Identifier
1366729493
Registry record updated Jul 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
0904007697 Issued in VA
Practice address
9416 Creek Summit Cir
Richmond, VA 23235-4277
Phone
(804) 819-4000
Fax
(804) 819-5221
NPI assigned
Nov 3, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 0904007697 VA Primary

Addresses

Primary practice location

9416 Creek Summit Cir
Richmond, VA 23235-4277

Mailing address

9416 Creek Summit Cir
Richmond, VA 23235-4277
Phone (804) 819-4000

Other names 1

  • Diane Saltzburg Former name

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

LicenseStateTypeSpecialty
0904007697VAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
M.I.N.K.S. Youth & Family Services Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1320278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406246400000",
    "number": "1366729493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9416 CREEK SUMMIT CIR",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232354277",
            "telephone_number": "804-819-4000",
            "fax_number": "804-819-5221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9416 CREEK SUMMIT CIR",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232354277",
            "telephone_number": "804-819-4000",
            "fax_number": "804-819-5221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "DIANE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-03",
        "last_updated": "2014-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904007697",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DIANE",
            "last_name": "SALTZBURG",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Richmond, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.