Active NPI
Marvellicia Antoinette Wilson, RCSWI
- Clinical Social Worker
- Jacksonville, FL
National Provider Identifier
1952148157
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- ISW20386
- Practice address
- 645 Bonaparte Dr
Jacksonville, FL 32218-6734 - Phone
- (571) 278-8127
- NPI assigned
- Jul 15, 2024
- Sex
- Female
- Sole proprietor
- Yes
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 | ISW20386 | FL | Primary |
Addresses
Primary practice location
645 Bonaparte Dr
Jacksonville, FL 32218-6734
Mailing address
645 Bonaparte Dr
Jacksonville, FL 32218-6734
Phone (571) 278-8127
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ISW20386 | FL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721001600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721001600000",
"number": "1952148157",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "645 BONAPARTE DR",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322186734",
"telephone_number": "571-278-8127"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "645 BONAPARTE DR",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322186734",
"telephone_number": "571-278-8127"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "MARVELLICIA",
"middle_name": "ANTOINETTE",
"name_prefix": "Mrs.",
"credential": "RCSWI",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-07-15",
"last_updated": "2024-07-15",
"certification_date": "2024-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "FL",
"license": "ISW20386",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.