Active NPI
Tisha Petelo, LCSW, MAC
- Clinical Social Worker
- Pago Pago, AS
National Provider Identifier
1487980611
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 809
- Practice address
- Fiatele Teo BLDG.
Airport Road 1005
Pago Pago, AS 96799-1005 - Phone
- (684) 699-3725
- NPI assigned
- Oct 22, 2009
- Last updated
- Oct 22, 2009
- 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 | 809 | CO | Primary |
Addresses
Primary practice location
Fiatele Teo BLDG.
Airport Road 1005
Pago Pago, AS 96799-1005
Mailing address
PO Box 1005
Pago Pago, AS 96799-1005
Phone (684) 699-3725
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 |
|---|---|---|---|
| 809 | CO | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1256169600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1256169600000",
"number": "1487980611",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1005",
"city": "PAGO PAGO",
"state": "AS",
"postal_code": "967991005",
"telephone_number": "684-699-3725"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "FIATELE TEO BLDG.",
"address_2": "AIRPORT ROAD 1005",
"city": "PAGO PAGO",
"state": "AS",
"postal_code": "967991005",
"telephone_number": "684-699-3725"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETELO",
"first_name": "TISHA",
"name_prefix": "Mrs.",
"credential": "LCSW, MAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-10-22",
"last_updated": "2009-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CO",
"license": "809",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pago Pago, AS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.