Donna Hardeman, LCSW – Clinical Social Worker

Key facts

NPI: 1659560951
Entity type: Individual (NPI type 1)
Primary specialty: Clinical Social Worker 1041C0700X
License: C005021 (NC)
Practice address: 120 Penmarc Dr
Suite 118
Raleigh, NC 27603-2400
Phone: (800) 632-6074
NPI assigned: Oct 23, 2007
Sex: Female
Sole proprietor: No

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.

Paradigm Health Psychiatric SRV, LLC Mental Health Counselor · Raleigh, NC · NPI 1770533945

NPD (past)
Paradigm Health Care Services, LLC Mental Health Counselor · Largo, FL · NPI 1336190495

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
C005021	NC	MD	Clinical Social Worker

Practice roles

Organization	Specialty	Status	New patients
Paradigm Health Psychiatric SRV, LLC		Past since Feb 8, 2011	Accepting new patients
Paradigm Health Care Services, LLC		Past since Oct 1, 2007	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Clinical Social Worker	1041C0700X	C005021	NC	Yes

Addresses

Primary practice location

120 Penmarc Dr
Suite 118
Raleigh, NC 27603-2400

Mailing address

PO Box 10414
C O Paradigm Health Services
Largo, FL 33773-0414

Other identifiers

Identifier	Type	State	Issuer
6106787	Medicaid	NC

Other names

Donna Tilley Former name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 19, 2007.

{
    "created_epoch": "1193097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195430400000",
    "number": "1659560951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10414",
            "address_2": "C O PARADIGM HEALTH SERVICES",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337730414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 PENMARC DR",
            "address_2": "SUITE 118",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276032400",
            "telephone_number": "800-632-6074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARDEMAN",
        "first_name": "DONNA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-23",
        "last_updated": "2007-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C005021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6106787",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DONNA",
            "last_name": "TILLEY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Raleigh, NC

All providers in Raleigh, NC · Clinical Social Worker in North Carolina

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 19, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.