Individual provider Active NPI

Elizabeth Dierker

  • Clinical Social Worker
  • Fort Worth, TX
National Provider Identifier
1669089769
Registry record updated Dec 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW-4446 Issued in HI
Practice address
1751 River Run Ste 200
Fort Worth, TX 76107-6670
Phone
(817) 330-9108
NPI assigned
Sep 23, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 10, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LCSW-4446 HI Primary

Addresses

Primary practice location

1751 River Run Ste 200
Fort Worth, TX 76107-6670

Mailing address

5900 Balcones Dr Ste 100
Austin, TX 78731-4298
Phone (817) 330-9108

Other names 1

  • N/a N/a N/a Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20210305000661 TX Practitioner - Clinical Social Worker 4082020672 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1751 River Run
Suite 200
Fort Worth, TX 76107-6670
Phone (817) 330-9108

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCSW-4446HIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Ellie Dierker Counseling, PLLC Clinical CurrentSince Oct 5, 2024 Accepting new patients

Locations

5900 Balcones Dr
Ste 100
Austin, TX 78731

1751 River Run
Ste 200
Ft Worth, TX 76107
Phone (682) 235-9884

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1600819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733788800000",
    "number": "1669089769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5900 BALCONES DR STE 100",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787314298",
            "telephone_number": "817-330-9108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1751 RIVER RUN STE 200",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761076670",
            "telephone_number": "817-330-9108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIERKER",
        "first_name": "ELIZABETH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-23",
        "last_updated": "2024-12-10",
        "certification_date": "2024-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "HI",
            "license": "LCSW-4446",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "N/A",
            "last_name": "N/A",
            "middle_name": "N/A",
            "credential": "LCSW",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.