Individual provider Active NPI

Jessica A Civiello

  • Clinical Social Worker
  • Mesa, AZ
National Provider Identifier
1790268936
Registry record updated Feb 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW-17233 Issued in AZ
Practice address
7227 E Baseline Rd Ste 126
Mesa, AZ 85209-5006
Phone
(480) 868-9650
Fax
(480) 834-3606
NPI assigned
Sep 13, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X LCSW-17233 AZ
Clinical Social Worker 1041C0700X LCSW-17233 AZ Primary

Addresses

Primary practice location

7227 E Baseline Rd Ste 126
Mesa, AZ 85209-5006

Mailing address

7227 E Baseline Rd Ste 126
Mesa, AZ 85209-5006
Phone (480) 868-9650

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
77.24 of 100Reported as group
Quality
66.21
Improvement activities
40
Cost
66.73

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCSW-17233AZMDClinical Social Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1536796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676419200000",
    "number": "1790268936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7227 E BASELINE RD STE 126",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852095006",
            "telephone_number": "480-868-9650",
            "fax_number": "480-834-3606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7227 E BASELINE RD STE 126",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852095006",
            "telephone_number": "480-868-9650",
            "fax_number": "480-834-3606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CIVIELLO",
        "first_name": "JESSICA",
        "middle_name": "A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-13",
        "last_updated": "2023-02-15",
        "certification_date": "2023-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "AZ",
            "license": "LCSW-17233",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AZ",
            "license": "LCSW-17233",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.