Active NPI
Olivia Gwaltney
- Clinical Social Worker
- Brandon, FL
National Provider Identifier
1730850702
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- SW21017
- Practice address
- 126 Lithia Pinecrest Rd
Brandon, FL 33511-5347 - Phone
- (813) 689-8828
- NPI assigned
- Sep 21, 2021
- 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 | SW21017 | FL | Primary |
Addresses
Primary practice location
126 Lithia Pinecrest Rd
Brandon, FL 33511-5347
Mailing address
126 Lithia Pinecrest Rd
Brandon, FL 33511-5347
Phone (813) 689-8828
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730850702 | Medicaid | FL |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SW21017 | FL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1632182400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675296000000",
"number": "1730850702",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "126 LITHIA PINECREST RD",
"city": "BRANDON",
"state": "FL",
"postal_code": "335115347",
"telephone_number": "813-689-8828"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "126 LITHIA PINECREST RD",
"city": "BRANDON",
"state": "FL",
"postal_code": "335115347",
"telephone_number": "813-689-8828"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GWALTNEY",
"first_name": "OLIVIA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-09-21",
"last_updated": "2023-02-02",
"certification_date": "2023-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "FL",
"license": "SW21017",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1730850702",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brandon, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.