Active NPI
Eduardo Villavicencio, MSW
- Clinical Social Worker
- Charlotte, NC
National Provider Identifier
1750642963
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- P007292
- Practice address
- 5338 Jocelyn LN
Charlotte, NC 28269-6184 - Phone
- (305) 600-7569
- NPI assigned
- Jun 4, 2012
- Sex
- Male
- 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 | P007292 | NC | Primary |
Addresses
Primary practice location
5338 Jocelyn LN
Charlotte, NC 28269-6184
Mailing address
5338 Jocelyn LN
Charlotte, NC 28269-6184
Phone (305) 600-7569
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P007292 | Other | NC | SOCIAL WORKER CERTIFICATION AND LICENSURE BOARD |
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 |
|---|---|---|---|
| P007292 | NC | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1338768000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1338768000000",
"number": "1750642963",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5338 JOCELYN LN",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282696184",
"telephone_number": "305-600-7569"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5338 JOCELYN LN",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282696184",
"telephone_number": "305-600-7569"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VILLAVICENCIO",
"first_name": "EDUARDO",
"credential": "MSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-06-04",
"last_updated": "2012-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "P007292",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SOCIAL WORKER CERTIFICATION AND LICENSURE BOARD",
"identifier": "P007292",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.