Tiffany Nicole Hendershot, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

DP00944330 Issued in WV

Practice address

100 Military Dr
South Charleston, WV 25309-8246

Phone

(304) 352-3613

NPI assigned

Nov 5, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2013

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Upstream Behavioral Health LLC

  • Clinical Social Worker
  • Berkeley Springs, WV
  • NPI 1962352211
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1541376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541376000000",
    "number": "1649748930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2525 PIGEON COVE RD",
            "city": "WARFORDSBURG",
            "state": "PA",
            "postal_code": "172678910",
            "telephone_number": "304-320-1165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MILITARY DR",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253098246",
            "telephone_number": "304-352-3613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSHOT",
        "first_name": "TIFFANY",
        "middle_name": "NICOLE",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-05",
        "last_updated": "2018-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WV",
            "license": "DP00944330",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hearing Place, Inc.
• Kaitlyn Hedrick
• Summer Heightland
• Daniel Helems
• Grant Crawford Henck, PHARM D
• Jason Wayne Henderson
• Montana Hendricks
• Alyshia Shadae Henry
• Destiny Nasha Henry
• Brenda G. Hensley, CRNA

• Clinical Social Worker in South Charleston, WV
• Providers in South Charleston, WV by specialty
• Clinical Social Worker in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.