Jennifer J Enevoldsen, LMSW, LCSW-P

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P006929 Issued in NC

Practice address

309 Wyche St
Henderson, NC 27536-4246

Phone

(252) 438-2581

Fax

(252) 431-9145

NPI assigned

Oct 4, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1286150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325721600000",
    "number": "1447569884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3210 FAIRHILL DR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276123215",
            "telephone_number": "252-438-2581",
            "fax_number": "252-431-9145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 WYCHE ST",
            "city": "HENDERSON",
            "state": "NC",
            "postal_code": "275364246",
            "telephone_number": "252-438-2581",
            "fax_number": "252-431-9145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENEVOLDSEN",
        "first_name": "JENNIFER",
        "middle_name": "J",
        "name_prefix": "Ms.",
        "credential": "LMSW, LCSW-P",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-04",
        "last_updated": "2012-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "SC",
            "license": "9534",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P006929",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "457633",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Henderson, NC
• Providers in Henderson, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2012; 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.