Active NPI
Loretta Clarise Pettiford, MSW,LICSW,LCSW-C,C.P
- Social Worker
- Lavale, MD
National Provider Identifier
1578764981
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 13717
- Practice address
- 12611 Henry Dr SW
Lavale, MD 21502-6147 - Phone
- (240) 727-2451
- Fax
- (301) 777-1951
- NPI assigned
- May 31, 2007
- 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 | 13717 | MD | Primary |
Addresses
Primary practice location
12611 Henry Dr SW
Lavale, MD 21502-6147
Mailing address
12611 Henry Dr SW
Lavale, MD 21502-6147
Phone (240) 727-2451
Other practice location 1
564 National Hwy
Lavale, MD 21502-7027
Phone (240) 727-2451
Other practice location 2
1629 K St NW
Washington, DC 20006-1602
Phone (240) 727-2451
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4172248 00 | Medicaid | MD |
Other names 1
- Mrs. Loretta Clarise Lane
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13717 | MD | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548979200000",
"number": "1578764981",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12611 HENRY DR SW",
"city": "LAVALE",
"state": "MD",
"postal_code": "215026147",
"telephone_number": "240-727-2451",
"fax_number": "301-777-1951"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12611 HENRY DR SW",
"city": "LAVALE",
"state": "MD",
"postal_code": "215026147",
"telephone_number": "240-727-2451",
"fax_number": "301-777-1951"
}
],
"practiceLocations": [
{
"address_1": "564 National Hwy",
"address_purpose": "LOCATION",
"city": "Lavale",
"state": "MD",
"postal_code": "215027027",
"country_code": "US",
"telephone_number": "240-727-2451",
"fax_number": "301-777-1951",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1629 K St NW",
"address_purpose": "LOCATION",
"city": "Washington",
"state": "DC",
"postal_code": "200061602",
"country_code": "US",
"telephone_number": "240-727-2451",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PETTIFORD",
"first_name": "LORETTA",
"middle_name": "CLARISE",
"name_prefix": "Mrs.",
"credential": "MSW,LICSW,LCSW-C,C.P",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-31",
"last_updated": "2019-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MD",
"license": "13717",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4172248 00",
"state": "MD"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "LORETTA",
"last_name": "LANE",
"middle_name": "CLARISE",
"prefix": "MRS.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Lavale, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.