Tara Nicole Mackie, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

99719 Issued in CA

Practice address

17284 Slover Ave # 105
Fontana, CA 92337-7584

Phone

(909) 609-3848

NPI assigned

Feb 23, 2021

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1614038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614038400000",
    "number": "1730773490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "792 VISTA REAL ST",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928797701",
            "telephone_number": "909-229-3640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17284 SLOVER AVE # 105",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923377584",
            "telephone_number": "909-609-3848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACKIE",
        "first_name": "TARA",
        "middle_name": "NICOLE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-23",
        "last_updated": "2021-02-23",
        "certification_date": "2021-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "99719",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "(PHI)",
            "affiliation": "N",
            "endpointDescription": "(PHI)",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "17284 Slover Ave # 105",
            "city": "Fontana",
            "state": "CA",
            "country_code": "US",
            "postal_code": "923377584",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Alan Enrique Machado, DDS
• Diane Macias
• Eduardo Pedro Macias, M.D.
• Madahi Gizeh Macias
• Douglas K. Mack, MD
• Heather J Maddox, RN, CRNA
• Nancy Madi
• Erica Firman Madiedo, M.A., CCC-A
• Kyleigh Madill
• Lisa A Madison, AUD

• Clinical Social Worker in Fontana, CA
• Providers in Fontana, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.