Active NPI
Autumn Renee Jacquette, LGSW
- Social Worker
- Rock Hall, MD
National Provider Identifier
1548717903
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 21142
- Practice address
- 5878 Henry Ave
Rock Hall, MD 21661-1342 - Phone
- (410) 310-8917
- NPI assigned
- Sep 2, 2016
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 21142 | MD | Primary |
Addresses
Primary practice location
5878 Henry Ave
Rock Hall, MD 21661-1342
Mailing address
PO Box 591
Rock Hall, MD 21661-0591
Phone (410) 310-8917
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 |
|---|---|---|---|
| 21142 | MD | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1472774400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1624579200000",
"number": "1548717903",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 591",
"city": "ROCK HALL",
"state": "MD",
"postal_code": "216610591",
"telephone_number": "410-310-8917"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5878 HENRY AVE",
"city": "ROCK HALL",
"state": "MD",
"postal_code": "216611342",
"telephone_number": "410-310-8917"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACQUETTE",
"first_name": "AUTUMN",
"middle_name": "RENEE",
"credential": "LGSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-09-02",
"last_updated": "2021-06-25",
"certification_date": "2021-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MD",
"license": "21142",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rock Hall, MD
- DRS. Rodek & Delvecchio, DDS, LLC
- Stephanie Ann Evans, PHARMD
- Jamie Larrimore Fleetwood, PHARMD
- Anna Marie Hall, LMSW
- Margaret Mary Hitzges, OT
- Kent County Public Schools
- Kent County Public Schools Infant & Toddler Program
- Leonard John Litkowski, DDS
- Rock Hall Volunteer Fire Co Inc
- Frances J. Rodney, O.T.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.