STACEY TIDWELL LCSW
NPI 1790189413
Social Worker - School in Stockton, CA

Q: What is Stacey Tidwell's NPI number?

The NPI number for Stacey Tidwell is 1790189413. It was assigned to this individual provider in the NPPES registry on October 9, 2014.

Q: What is Stacey Tidwell's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in School, with taxonomy code 1041S0200X.

Q: When was this NPI record last updated?

The NPPES record for Stacey Tidwell was last updated on December 30, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since October 09, 2014PECOS Enrolled

3311 MORADA LN, STOCKTON, CA 95212(209) 647-3047 Get Directions Write a Review

NPPES record last updated: December 30, 2021. Verified against the NPPES registry weekly; last sync: August 23, 2026.

Record update history: Dec 30, 2021, Sep 3, 2020, Mar 14, 2018 (3 updates tracked since 2018).

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About Stacey Tidwell Lcsw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

STACEY TIDWELL LCSW (NPI 1790189413) is an individual school provider in Stockton, California and active in the NPI registry since October 2014. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1790189413

Entity TypeIndividualFemale

Primary Taxonomy1041S0200X

Provider Legal NameSTACEY TIDWELLCredential: LCSW

Location Address3311 MORADA LNStockton, CA 95212-3148

Mailing Address3311 Morada LnStockton, CA 95212-3148 · (209) 647-3047

Phone(209) 647-3047

Sole ProprietorNo

Enumeration DateOctober 9, 2014

Last NPPES UpdateDecember 30, 20213 updates tracked since enumeration

NPPES CertifiedSeptember 3, 2020

✔ NPI 1790189413 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · SchoolBehavioral Health & Social Service Providers

Taxonomy Code1041S0200X

3311 MORADA LN, Stockton, CA 95212

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Stacey Tidwell Lcsw is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Stacey Tidwell's NPI number?

The NPI number for Stacey Tidwell is 1790189413. It was assigned to this individual provider in the NPPES registry on October 9, 2014.

Where is Stacey Tidwell located?

Stacey Tidwell practices at 3311 Morada Ln, Stockton, CA 95212. The listed phone number is (209) 647-3047.

What is Stacey Tidwell's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in School, with taxonomy code 1041S0200X.

Is Stacey Tidwell enrolled in Medicare?

Yes. Stacey Tidwell is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Stacey Tidwell was last updated on December 30, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.