Individual provider Active NPI

Candace Keith Perkins, LCSW

  • Clinical Social Worker
  • Jacksonville, FL
National Provider Identifier
1972624666
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SW1547 Issued in FL
Practice address
4465 Baymeadows Road
Suite 1
Jacksonville, FL 32217
Phone
(904) 858-3312
Fax
(904) 737-9369
NPI assigned
Apr 2, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 SW1547 FL Primary

Addresses

Primary practice location

4465 Baymeadows Road
Suite 1
Jacksonville, FL 32217

Mailing address

4465 Baymeadows Road
Suite 1
Jacksonville, FL 32217
Phone (904) 858-3312

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

LicenseStateTypeSpecialty
SW1547FLMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1972624666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4465 BAYMEADOWS ROAD",
            "address_2": "SUITE 1",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32217",
            "telephone_number": "904-858-3312",
            "fax_number": "904-737-9369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4465 BAYMEADOWS ROAD",
            "address_2": "SUITE 1",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32217",
            "telephone_number": "904-858-3312",
            "fax_number": "904-737-9369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERKINS",
        "first_name": "CANDACE",
        "middle_name": "KEITH",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW1547",
            "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 8, 2007; 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.