Active NPI
Tahria Marie Gipson, LCSW
- Clinical Social Worker
- Jacksonville, FL
National Provider Identifier
1407027972
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 9851
- Practice address
- 9503 Plum Lake LN W
Jacksonville, FL 32222-1573 - Phone
- (240) 421-9057
- NPI assigned
- Mar 12, 2008
- 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 | 9851 | FL | Primary |
Addresses
Primary practice location
9503 Plum Lake LN W
Jacksonville, FL 32222-1573
Mailing address
9503 Plum Lake LN W
Jacksonville, FL 32222-1573
Phone (240) 421-9057
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9851 | FL | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Counseling & Mentoring Services, Inc | Past | Accepting new patients | |
| Community Counseling & Mentoring Services,Inc | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Clinic/Center
- Largo, MD
- NPI 1306881057
-
- Clinic/Center
- Largo, MD
- NPI 1942462049
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1205280000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692921600000",
"number": "1407027972",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9503 PLUM LAKE LN W",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322221573",
"telephone_number": "240-421-9057"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9503 PLUM LAKE LN W",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322221573",
"telephone_number": "240-421-9057"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIPSON",
"first_name": "TAHRIA",
"middle_name": "MARIE",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-03-12",
"last_updated": "2023-08-25",
"certification_date": "2023-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "FL",
"license": "9851",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.