Active NPI
Christine Dougherty, LCSW
- Clinical Social Worker
- Vista, CA
National Provider Identifier
1003194960
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 26686
- Practice address
- 1000 Vale Terrace Dr
Vista, CA 92084-5218 - Phone
- (760) 631-5000
- NPI assigned
- Jul 26, 2011
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 26686 | CA | Primary |
Addresses
Primary practice location
1000 Vale Terrace Dr
Vista, CA 92084-5218
Mailing address
1000 Vale Terrace Dr
Vista, CA 92084-5218
Phone (760) 631-5000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200420000172 | CA | Order and Referring Only - Clinical Social Worker | 3072943885 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26686 | CA | MD | Clinical Psychologist |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Interoperability endpoints
- christine.doughertylcsw.p1@direct.vistacommunityclinic.nextgenshare.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1311638400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1584403200000",
"number": "1003194960",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 VALE TERRACE DR",
"city": "VISTA",
"state": "CA",
"postal_code": "920845218",
"telephone_number": "760-631-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 VALE TERRACE DR",
"city": "VISTA",
"state": "CA",
"postal_code": "920845218",
"telephone_number": "760-631-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUGHERTY",
"first_name": "CHRISTINE",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-07-26",
"last_updated": "2020-03-17",
"certification_date": "2020-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "26686",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Vista, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.