Active NPI
Antonia Eberhart
- Clinical Social Worker
- Renton, WA
National Provider Identifier
1922654565
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- SC60984451
- Practice address
- 15 S Grady Way Ste 249
Renton, WA 98057-3209 - Phone
- (253) 843-6330
- NPI assigned
- Aug 9, 2019
- Last updated
- Sep 6, 2019
- 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 | SC60984451 | WA | Primary |
Addresses
Primary practice location
15 S Grady Way Ste 249
Renton, WA 98057-3209
Mailing address
15 S Grady Way Ste 249
Renton, WA 98057-3209
Phone (253) 220-9452
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 21, 2024 through Mar 21, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SC60984451 | WA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1565308800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1567728000000",
"number": "1922654565",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 S GRADY WAY STE 249",
"city": "RENTON",
"state": "WA",
"postal_code": "980573209",
"telephone_number": "253-220-9452"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 S GRADY WAY STE 249",
"city": "RENTON",
"state": "WA",
"postal_code": "980573209",
"telephone_number": "253-843-6330"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EBERHART",
"first_name": "ANTONIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-08-09",
"last_updated": "2019-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WA",
"license": "SC60984451",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Renton, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.