Active NPI
Stacey Reynolds, MSW
- Clinical Social Worker
- Fort Worth, TX
National Provider Identifier
1780143404
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 3840 Hulen St
Fort Worth, TX 76107-7277 - Phone
- (817) 569-4300
- NPI assigned
- Mar 13, 2019
- 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 | 66465 | TX | |
| Clinical Social Worker | 1041C0700X | Primary |
Addresses
Primary practice location
3840 Hulen St
Fort Worth, TX 76107-7277
Mailing address
PO Box 2603
Fort Worth, TX 76113-2603
Phone (817) 569-4300
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 66465 | TX | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1552435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684886400000",
"number": "1780143404",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2603",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761132603",
"telephone_number": "817-569-4300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3840 HULEN ST",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761077277",
"telephone_number": "817-569-4300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REYNOLDS",
"first_name": "STACEY",
"credential": "MSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-03-13",
"last_updated": "2023-05-24",
"certification_date": "2023-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "TX",
"license": "66465",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 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.