Active NPI
Carrie Bacon
- Clinical Social Worker
- Millersville, MD
National Provider Identifier
1770032682
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 14799
- Practice address
- 1114 Benfield Blvd
Millersville, MD 21108-2568 - Phone
- (410) 780-5203
- Fax
- (410) 780-5205
- NPI assigned
- Oct 4, 2016
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 14799 | MD | Primary |
| Clinical Social Worker | 1041C0700X | LIC50079475 | DC |
Addresses
Primary practice location
1114 Benfield Blvd
Millersville, MD 21108-2568
Mailing address
8967 Yellow Brick Rd
Rosedale, MD 21237-2303
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 |
|---|---|---|---|
| LIC50079475 | DC | MD | Clinical Social Worker |
| 14799 | MD | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1475539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475539200000",
"number": "1770032682",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8967 YELLOW BRICK RD",
"city": "ROSEDALE",
"state": "MD",
"postal_code": "212372303"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1114 BENFIELD BLVD",
"city": "MILLERSVILLE",
"state": "MD",
"postal_code": "211082568",
"telephone_number": "410-780-5203",
"fax_number": "410-780-5205"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BACON",
"first_name": "CARRIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-10-04",
"last_updated": "2016-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MD",
"license": "14799",
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "DC",
"license": "LIC50079475",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Millersville, MD
- Mindy K Athas, RD, RDN
- Michelle Ayoroa-Perez, DDS
- B Love, Inc.
- Christina Bachenberg, LCPC
- Stefanie Leahy Bachmann, M.A., NCSP, LCPC
- Deborah L Badro, CRNP
- Baltimore Washington Counseling Center, LLC
- Baltimore Washington Counseling Center, LLC
- Baltimore Washington Professional Services Inc.
- Michael Antonio Banos-Perez
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.