Active NPI
Meagan K Maddock, LCSW
- Clinical Social Worker
- Buena Vista, CO
National Provider Identifier
1770179665
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 097130
- Practice address
- 25777 County Road 321
Buena Vista, CO 81211-9774 - Phone
- (303) 717-5074
- NPI assigned
- Dec 15, 2020
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 104473 | CA | |
| Clinical Social Worker | 1041C0700X | 097130 | NY | Primary |
Addresses
Primary practice location
25777 County Road 321
Buena Vista, CO 81211-9774
Mailing address
25777 County Road 321
Buena Vista, CO 81211-9774
Phone (303) 717-5074
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 |
|---|---|---|---|
| 104473 | CA | MD | Social Worker |
| 097130 | NY | MD | Cardiovascular Disease Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1607990400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1711324800000",
"number": "1770179665",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25777 COUNTY ROAD 321",
"city": "BUENA VISTA",
"state": "CO",
"postal_code": "812119774",
"telephone_number": "303-717-5074"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25777 COUNTY ROAD 321",
"city": "BUENA VISTA",
"state": "CO",
"postal_code": "812119774",
"telephone_number": "303-717-5074"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MADDOCK",
"first_name": "MEAGAN",
"middle_name": "K",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-12-15",
"last_updated": "2024-03-25",
"certification_date": "2024-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "CA",
"license": "104473",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "097130",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Buena Vista, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.