NPIMap

Individual provider Active NPI

Hattie Faye Bordeaux, LCSW

  • Clinical Social Worker
  • Greenville, NC
National Provider Identifier
1801997531
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
COO1908 Issued in NC
Practice address
622 S Memorial Dr
Greenville, NC 27834-2854
Phone
(252) 353-4250
Fax
(252) 353-4228
NPI assigned
Sep 26, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X COO1908 NC Primary

Addresses

Primary practice location

622 S Memorial Dr
Greenville, NC 27834-2854

Mailing address

622 S Memorial Dr
Greenville, NC 27834-2854
Phone (252) 353-4250

Other identifiers 1

IdentifierTypeStateIssuer
6003195MedicaidNC

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

LicenseStateTypeSpecialty
COO1908NCMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Cambridge Behavioral Health Services Past Accepting new patients
Cambridge Behavioral Health Services Past Accepting new patients
Cambridge Behavioral Health Services Past Accepting new patients
Cambridge Behavioral Health Services Past Accepting new patients
Cambridge Behavioral Health Services Past Accepting new patients
Cambridge Behavioral Health Services Past Accepting new patients
Cambridge Behavioral Health Services Past Accepting new patients
Cambridge Day Past Accepting new patients

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1801997531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "622 S MEMORIAL DR",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278342854",
            "telephone_number": "252-353-4250",
            "fax_number": "252-353-4228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 S MEMORIAL DR",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278342854",
            "telephone_number": "252-353-4250",
            "fax_number": "252-353-4228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORDEAUX",
        "first_name": "HATTIE",
        "middle_name": "FAYE",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "COO1908",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6003195",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, NC

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.

Verify at the official NPI Registry.