Heather Anne Radcliffe, LICSW ACSW
Individual provider Active NPI Clinical Social Worker · Bridgeport, WV
NPI 1649539396 · NPPES record last updated Sep 7, 2022
Key facts
- NPI
- 1649539396
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- DP00941015 (WV)
- Practice address
- 65 Professional PL Ste 102103
Bridgeport, WV 26330-0258 - Phone
- (304) 848-5770
- Fax
- (304) 848-0980
- NPI assigned
- May 15, 2012
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 61
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WV
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120803000706 | WV | Practitioner - Clinical Social Worker | 1951557115 | Reassigns benefits to 28 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles (60 of 61)
Locations (25 of 26)
65 Professional Pl
Ste 103
Bridgeport, WV 26330
Phone (304) 848-5770
65 Professional Pl
Ste 101
Bridgeport, WV 26330
Phone (304) 842-6463
34 N Kanawha St
Buckhannon, WV 26201
Phone (304) 473-2250
4 Northridge Dr
Ste 118
Buckhannon, WV 26201
Phone (304) 473-1440
228 Kanawha Ave
Burnsville, WV 26335
Phone (304) 713-3105
1400 N 19th St
Clarksburg, WV 26301
Phone (304) 326-7650
1 Mountaineer Dr
Clarksburg, WV 26301
Phone (304) 326-7470
2 Mountaineer Dr
Clarksburg, WV 26301
Phone (304) 326-7620
142 Flatwoods Corner Rd
Flatwoods, WV 26621
Phone (304) 402-2023
113 5th St
Gassaway, WV 26624
Phone (304) 364-5867
6536 Main St
Jane Lew, WV 26378
Phone (304) 884-2307
15300 US Highway 33 W
Linn, WV 26384
Phone (304) 804-2055
1176 Oil Creek Rd
Roanoke, WV 26447
Phone (304) 452-0001
100 Carter Braxton Dr
Sutton, WV 26601
Phone (304) 765-2644
55 Little Birch Rd
Sutton, WV 26601
Phone (304) 765-2881
200 Jerry Burton Dr
Sutton, WV 26601
Phone (304) 765-7331
235 Skidmore Ln
Sutton, WV 26601
Phone (304) 765-4400
249 Skidmore Ln
Sutton, WV 26601
Phone (304) 317-7275
288 N Hill Rd
Sutton, WV 26601
Phone (304) 402-2105
266 Skidmore Ln
Sutton, WV 26601
Phone (304) 765-0351
358 Court Ave
Weston, WV 26452
Phone (304) 269-0041
149 Staunton Dr
Weston, WV 26452
Phone (304) 269-2022
107 Staunton Dr
Weston, WV 26452
Phone (304) 269-2022
509 Berlin Rd
Weston, WV 26452
Phone (304) 269-0029
133 Staunton Dr
Weston, WV 26452
Phone (304) 269-9510
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | DP00941015 | WV | Yes |
Addresses
Primary practice location
65 Professional PL Ste 102103
Bridgeport, WV 26330-0258
Mailing address
65 Professional PL Ste 102103
Bridgeport, WV 26330-0258
Phone (304) 848-5770
Other practice location 1
1512 Dawn Dr # 2
Fairmont, WV 26554-9246
Phone (304) 657-1473
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649539396 | Medicaid | WV |
NPI Registry JSON
{
"created_epoch": "1337040000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1662508800000",
"number": "1649539396",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "65 PROFESSIONAL PL STE 102103",
"city": "BRIDGEPORT",
"state": "WV",
"postal_code": "263300258",
"telephone_number": "304-848-5770",
"fax_number": "304-848-0980"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "65 PROFESSIONAL PL STE 102103",
"city": "BRIDGEPORT",
"state": "WV",
"postal_code": "263300258",
"telephone_number": "304-848-5770",
"fax_number": "304-848-0980"
}
],
"practiceLocations": [
{
"address_1": "1512 Dawn Dr # 2",
"address_purpose": "LOCATION",
"city": "Fairmont",
"state": "WV",
"postal_code": "265549246",
"country_code": "US",
"telephone_number": "304-657-1473",
"fax_number": "304-212-7731",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "RADCLIFFE",
"first_name": "HEATHER",
"middle_name": "ANNE",
"credential": "LICSW ACSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-05-15",
"last_updated": "2022-09-07",
"certification_date": "2022-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WV",
"license": "DP00941015",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1649539396",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bridgeport, WV
- Jennifer Pulice
- Meredith Brianne Queen
- Amber Brook Quinn
- Luis Horacio Quiroga
- Eric J Radcliffe
- Salam H Rajjoub
- Robin Annette Raleigh
- Vigneshwaran Ramanathan
- Cheyenne Ramsey
- Darrian N Randall
All providers in Bridgeport, WV · Clinical Social Worker in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 7, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.