Individual provider Active NPI

Peter Golladay, LCSW

  • Clinical Social Worker
  • Blacksburg, VA
National Provider Identifier
1942514583
Registry record updated Aug 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
0904007347 Issued in VA
Practice address
700 University City Blvd
Blacksburg, VA 24060-2706
Phone
(540) 961-8300
NPI assigned
Aug 5, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2010

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 0904007347 VA Primary

Addresses

Primary practice location

700 University City Blvd
Blacksburg, VA 24060-2706

Mailing address

700 University City Blvd
Blacksburg, VA 24060-2706
Phone (540) 961-8300

Other identifiers 1

IdentifierTypeStateIssuer
CO3501MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140115000016 VA Practitioner - Clinical Social Worker 8426286683 Practice locations: Blacksburg, VA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

100 Hubbard St
Suite C
Blacksburg, VA 24060-5745
Phone (540) 239-9321

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0904007347VAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Healing Tree Counseling Past Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1280966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280966400000",
    "number": "1942514583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 UNIVERSITY CITY BLVD",
            "city": "BLACKSBURG",
            "state": "VA",
            "postal_code": "240602706",
            "telephone_number": "540-961-8300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 UNIVERSITY CITY BLVD",
            "city": "BLACKSBURG",
            "state": "VA",
            "postal_code": "240602706",
            "telephone_number": "540-961-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLLADAY",
        "first_name": "PETER",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-05",
        "last_updated": "2010-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904007347",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CO3501",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Blacksburg, VA

Sources for this page

Verify at the official NPI Registry.