Active NPI
Mary Carol Misulich, LCSW
- Clinical Social Worker
- Maryville, TN
National Provider Identifier
1700852506
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LSW0000003452
- Practice address
- 262 Cherokee Professional Park
Maryville, TN 37804-5153 - Phone
- (865) 984-4223
- Fax
- (865) 681-1789
- NPI assigned
- Feb 23, 2006
- Sex
- Female
- Sole proprietor
- No
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 | LSW0000003452 | TN | Primary |
Addresses
Primary practice location
262 Cherokee Professional Park
Maryville, TN 37804-5153
Mailing address
262 Cherokee Professional Park
Maryville, TN 37804-5153
Phone (865) 984-4223
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LSW0000003452 | TN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140652800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1203984000000",
"number": "1700852506",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "262 CHEROKEE PROFESSIONAL PARK",
"city": "MARYVILLE",
"state": "TN",
"postal_code": "378045153",
"telephone_number": "865-984-4223",
"fax_number": "865-681-1789"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "262 CHEROKEE PROFESSIONAL PARK",
"city": "MARYVILLE",
"state": "TN",
"postal_code": "378045153",
"telephone_number": "865-984-4223",
"fax_number": "865-681-1789"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MISULICH",
"first_name": "MARY",
"middle_name": "CAROL",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-23",
"last_updated": "2008-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TN",
"license": "LSW0000003452",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Maryville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.