Active NPI
Sally A Fowler, LCSW
- Clinical Social Worker
- Jacksonville, FL
National Provider Identifier
1780736991
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- SW5174
- Practice address
- 3601 Hendricks Avenue
Jacksonville, FL 32207 - Phone
- (904) 396-2666
- Fax
- (904) 396-2698
- NPI assigned
- Jan 17, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | SW5174 | FL | Primary |
Addresses
Primary practice location
3601 Hendricks Avenue
Jacksonville, FL 32207
Mailing address
3601 Hendricks Avenue
Jacksonville, FL 32207
Phone (904) 396-2666
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9154134 | Other | PRIVATE HEALTHCARE SYSTEM | |
| Z117E | Other | FL | BLUE CROSS BLUE SHIELD |
| Z0894 | Other | FL | BLUE CROSS BLUE SHIELD |
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 |
|---|---|---|---|
| SW5174 | FL | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sheldon J Kaplan PHD and Associates | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Psychologist
- Jacksonville, FL
- NPI 1588716799
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168992000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1780736991",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3601 HENDRICKS AVENUE",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "32207",
"telephone_number": "904-396-2666",
"fax_number": "904-396-2698"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3601 HENDRICKS AVENUE",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "32207",
"telephone_number": "904-396-2666",
"fax_number": "904-396-2698"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOWLER",
"first_name": "SALLY",
"middle_name": "A",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "FL",
"license": "SW5174",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRIVATE HEALTHCARE SYSTEM",
"identifier": "9154134",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "Z117E",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "Z0894",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.