Active NPI
Jackie L Stout, LCSW
- Clinical Social Worker
- Vienna, VA
National Provider Identifier
1518280536
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 0904007252
- Practice address
- 410 Maple Ave W
Suite 7
Vienna, VA 22180-4224 - Phone
- (703) 342-4671
- NPI assigned
- Mar 4, 2010
- 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 | 0904007252 | VA | Primary |
Addresses
Primary practice location
410 Maple Ave W
Suite 7
Vienna, VA 22180-4224
Mailing address
410 Maple Ave W
Suite 7
Vienna, VA 22180-4224
Phone (703) 342-4671
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jul 1, 2014 through Jul 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0904007252 | VA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1267660800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1267660800000",
"number": "1518280536",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "410 MAPLE AVE W",
"address_2": "SUITE 7",
"city": "VIENNA",
"state": "VA",
"postal_code": "221804224",
"telephone_number": "703-342-4671"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "410 MAPLE AVE W",
"address_2": "SUITE 7",
"city": "VIENNA",
"state": "VA",
"postal_code": "221804224",
"telephone_number": "703-342-4671"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STOUT",
"first_name": "JACKIE",
"middle_name": "L",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-03-04",
"last_updated": "2010-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "VA",
"license": "0904007252",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vienna, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.