Individual provider Active NPI

Joseph Patrick Smullen, LCSW-S

  • Social Worker
  • Victoria, TX
National Provider Identifier
1972843407
Registry record updated Oct 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
57483 Issued in TX
Practice address
5606 N Navarro St Ste 302a
Victoria, TX 77904-1770
Phone
(361) 210-6898
Fax
(832) 324-7856
NPI assigned
Feb 20, 2013
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 2, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 574813 TX
Social Worker 104100000X 57483 TX Primary

Addresses

Primary practice location

5606 N Navarro St Ste 302a
Victoria, TX 77904-1770

Mailing address

604E Polk Ave
Victoria, TX 77901-2604
Phone (361) 237-0729

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20170410000690 TX Practitioner - Clinical Social Worker 7315223179 Practice locations: Victoria, TX

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

5606 N Navarro St
Suite 302C
Victoria, TX 77904-1770
Phone (361) 210-6898

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
574813TXMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Raul R Capitaine Mdpa CurrentSince Nov 1, 2020 Accepting new patients

Locations

1801 N Laurent St
Ste 107
Victoria, TX 77901
Phone (361) 212-8300

1402 Village Dr
Ste A
Victoria, TX 77901
Phone (361) 570-1444

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": "1361318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696204800000",
    "number": "1972843407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "604E POLK AVE",
            "city": "VICTORIA",
            "state": "TX",
            "postal_code": "779012604",
            "telephone_number": "361-237-0729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5606 N NAVARRO ST STE 302A",
            "city": "VICTORIA",
            "state": "TX",
            "postal_code": "779041770",
            "telephone_number": "361-210-6898",
            "fax_number": "832-324-7856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMULLEN",
        "first_name": "JOSEPH",
        "middle_name": "PATRICK",
        "credential": "LCSW-S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-02-20",
        "last_updated": "2023-10-02",
        "certification_date": "2023-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "574813",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "TX",
            "license": "57483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Victoria, TX

Sources for this page

Verify at the official NPI Registry.