Active NPI
Gwendolyn D Peacock, LCSW
- Clinical Social Worker
- Tucson, AZ
National Provider Identifier
1649994880
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 19061
- Practice address
- 3728 E Mecate Rd
Tucson, AZ 85739-8339 - Phone
- (810) 955-3819
- NPI assigned
- Sep 30, 2022
- Last updated
- Sep 30, 2022
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 19061 | AZ | Primary |
Addresses
Primary practice location
3728 E Mecate Rd
Tucson, AZ 85739-8339
Mailing address
3728 E Mecate Rd
Tucson, AZ 85739-8339
Phone (810) 955-3819
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
Buckeye, AZ 85396
Phone (240) 201-3386
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19061 | AZ | MD | Clinical Social Worker |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1664496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664496000000",
"number": "1649994880",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3728 E MECATE RD",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857398339",
"telephone_number": "810-955-3819"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3728 E MECATE RD",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857398339",
"telephone_number": "810-955-3819"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEACOCK",
"first_name": "GWENDOLYN",
"middle_name": "D",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-09-30",
"last_updated": "2022-09-30",
"certification_date": "2022-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "AZ",
"license": "19061",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tucson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2022; 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.