Individual provider Active NPI

Mallory Parker

  • Clinical Social Worker
  • Goldsboro, NC
National Provider Identifier
1588183602
Registry record updated Dec 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
P011745 Issued in NC
Practice address
1706 Wayne Memorial Dr
Goldsboro, NC 27534-2240
Phone
(919) 734-6676
NPI assigned
Sep 11, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 20, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior TechnicianGroup: 193200000X MULTI-SPECIALTY GROUP 106S00000X
Clinical Social Worker 1041C0700X P011745 NC Primary

Addresses

Primary practice location

1706 Wayne Memorial Dr
Goldsboro, NC 27534-2240

Mailing address

111 Mackenan Dr
Cary, NC 27511-7903

Other practice location 1

111 Mackenan Dr
Cary, NC 27511-7903
Phone (919) 371-2848

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

LicenseStateTypeSpecialty
P011745NCMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Waynesboro Family Clinic Multi-Specialty CurrentSince Dec 22, 2019 Accepting new patients
Wayne Cares Inc. PastSince Dec 22, 2019 Accepting new patients

Locations

1706 Wayne Memorial Dr
Goldsboro, NC 27534
Phone (919) 734-6676

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1505088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576800000000",
    "number": "1588183602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 MACKENAN DR",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275117903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1706 WAYNE MEMORIAL DR",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275342240",
            "telephone_number": "919-734-6676"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 Mackenan Dr",
            "address_purpose": "LOCATION",
            "city": "Cary",
            "state": "NC",
            "postal_code": "275117903",
            "country_code": "US",
            "telephone_number": "919-371-2848",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARKER",
        "first_name": "MALLORY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-09-11",
        "last_updated": "2019-12-20",
        "certification_date": "2019-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P011745",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Goldsboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 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.

Verify at the official NPI Registry.