Active NPI
Tracy Ann Carroll, LCSW
- Clinical Social Worker
- Midlothian, VA
National Provider Identifier
1639770597
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 0904011086
- Practice address
- 16200 Saville Chase LN
Midlothian, VA 23112-4585 - Phone
- (804) 347-1340
- NPI assigned
- Nov 5, 2020
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 81098 | CA | |
| Clinical Social Worker | 1041C0700X | 0904011086 | VA | Primary |
Addresses
Primary practice location
16200 Saville Chase LN
Midlothian, VA 23112-4585
Mailing address
16200 Saville Chase LN
Midlothian, VA 23112-4585
Phone (804) 347-1340
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 81098 | Other | CA | CALIFORNIA BOARD OF BEHAVIORAL SCIENCES |
| 0904011086 | Other | VA | COMMONWEALTH OF VIRGINIA DEPARTMENT OF HEALTH PROFESSIONS |
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 |
|---|---|---|---|
| 0904011086 | VA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604534400000",
"number": "1639770597",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16200 SAVILLE CHASE LN",
"city": "MIDLOTHIAN",
"state": "VA",
"postal_code": "231124585",
"telephone_number": "804-347-1340"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16200 SAVILLE CHASE LN",
"city": "MIDLOTHIAN",
"state": "VA",
"postal_code": "231124585",
"telephone_number": "804-347-1340"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARROLL",
"first_name": "TRACY",
"middle_name": "ANN",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-11-05",
"last_updated": "2020-11-05",
"certification_date": "2020-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "81098",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "VA",
"license": "0904011086",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CALIFORNIA BOARD OF BEHAVIORAL SCIENCES",
"identifier": "81098",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMMONWEALTH OF VIRGINIA DEPARTMENT OF HEALTH PROFESSIONS",
"identifier": "0904011086",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Midlothian, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.