Timisha Malone, LICSW

Key facts

NPI

1801307178

Entity type

Individual (NPI type 1)

Primary specialty

Clinical Social Worker 1041C0700X

Practice address

237 Hedding Rd
Epping, NH 03042-1525

Phone

(603) 815-2327

NPI assigned

Oct 13, 2017

Sex

Female

Sole proprietor

Yes

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.

• Time for a Change Wellness Clinical Social Worker · Epping, NH · NPI 1508592577
  Medicare reassignment NPD Authorized official CLINICAL · NH

Medicare Care Compare profile

Specialty

Clinical Social Worker

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare participation

Medicare fee-for-service enrollment

Enrolled in NH

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Practice roles

Locations

Specialties & licenses

Addresses

Other names

• Timisha Johnson Former name

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 1, 2022.

{
    "created_epoch": "1507852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661990400000",
    "number": "1801307178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "237 HEDDING RD",
            "city": "EPPING",
            "state": "NH",
            "postal_code": "030421525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "237 HEDDING RD",
            "city": "EPPING",
            "state": "NH",
            "postal_code": "030421525",
            "telephone_number": "603-815-2327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALONE",
        "first_name": "TIMISHA",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-10-13",
        "last_updated": "2022-09-01",
        "certification_date": "2022-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TIMISHA",
            "last_name": "JOHNSON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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