Active NPI
Iva Maylene Hallsted Clearwater, LCSW
- Clinical Social Worker
- Fort Pierce, FL
National Provider Identifier
1952419749
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- SW4959
- Practice address
- 4500 W Midway Rd
New Horizons of the Treasure Coast Inc
Ft Pierce, FL 34981 - Phone
- (772) 672-5600
- Fax
- (772) 468-4033
- NPI assigned
- Aug 29, 2006
- Last updated
- Sep 25, 2013
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 1803 | FL | |
| Clinical Social Worker | 1041C0700X | SW4959 | FL | Primary |
Addresses
Primary practice location
4500 W Midway Rd
New Horizons of the Treasure Coast Inc
Ft Pierce, FL 34981
Mailing address
4500 W Midway Rd
New Horizons of the Treasure Coast Inc
Ft Pierce, FL 34981
Phone (772) 672-5600
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 763665200 | Medicaid | FL | |
| 28762 | Other | FL | BCBS BLUE CROSS BLUE SHIE |
| 238116 | Other | FL | MHN MANAGED CARE ORG |
| 2027492 | Other | FL | CIGNA |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 1803 | FL | MD | Addiction (Substance Use Disorder) Counselor |
| SW4959 | FL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1380067200000",
"number": "1952419749",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4500 W MIDWAY RD",
"address_2": "NEW HORIZONS OF THE TREASURE COAST INC",
"city": "FT PIERCE",
"state": "FL",
"postal_code": "34981",
"telephone_number": "772-672-5600",
"fax_number": "772-468-4033"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4500 W MIDWAY RD",
"address_2": "NEW HORIZONS OF THE TREASURE COAST INC",
"city": "FT PIERCE",
"state": "FL",
"postal_code": "34981",
"telephone_number": "772-672-5600",
"fax_number": "772-468-4033"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLEARWATER",
"first_name": "IVA",
"middle_name": "MAYLENE HALLSTED",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-29",
"last_updated": "2013-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "FL",
"license": "1803",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "FL",
"license": "SW4959",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "763665200",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS BLUE CROSS BLUE SHIE",
"identifier": "28762",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MHN MANAGED CARE ORG",
"identifier": "238116",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "2027492",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Pierce, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.