Teresa Ellsworth, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

TERESA ELLSWORTH, LCSW

Practice address

2219 Harbor Lake Dr
Fleming Island, FL 32003-7796

Phone

(734) 673-3075

Fax

(904) 375-8347

NPI assigned

Jan 14, 2019

Last updated

Jan 14, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Teresa Ellsworth, LCSWNPI 1366650954

Title

Owner

Phone

(734) 673-3075

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Teresa Ellsworth, LCSW

  • Clinical Social Worker
  • Fort Sam Houston, TX
  • NPI 1366650954
  NPD (past) Authorized official

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

{
    "created_epoch": "1547424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547424000000",
    "number": "1871067736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2219 HARBOR LAKE DR",
            "city": "FLEMING ISLAND",
            "state": "FL",
            "postal_code": "320037796",
            "telephone_number": "734-673-3075",
            "fax_number": "904-375-8347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2219 HARBOR LAKE DR",
            "city": "FLEMING ISLAND",
            "state": "FL",
            "postal_code": "320037796",
            "telephone_number": "734-673-3075",
            "fax_number": "904-375-8347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TERESA ELLSWORTH, LCSW",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-14",
        "last_updated": "2019-01-14",
        "status": "A",
        "authorized_official_last_name": "ELLSWORTH",
        "authorized_official_first_name": "TERESA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "734-673-3075",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda R Taylor, PA-C
• Karrie Taylor
• Krista Taylor, OTD, OTR/L
• Amy E Tedeschi, PHARMD
• Corinna Enid Temple
• Jeffrey Terry
• Laura Rodrigues Theodule
• Lynn R Thibodeau, PA
• Sterling Lee Thomas, DO
• Thoughtful Psychiatry

• Clinical Social Worker in Fleming Island, FL
• Providers in Fleming Island, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2019; 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.