Active NPI
Kimberly Nicole Clayton
- Clinical Social Worker
- San Dimas, CA
National Provider Identifier
1023261005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW29139
- Practice address
- 1900 Sycamore Canyon Rd
San Dimas, CA 91773 - Phone
- (909) 599-2361
- NPI assigned
- Nov 4, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 | LCSW29139 | CA | Primary |
Addresses
Primary practice location
1900 Sycamore Canyon Rd
San Dimas, CA 91773
Mailing address
550 S Vermont
Los Angeles, CA 90020
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 |
|---|---|---|---|
| 29139 | CA | MD | Psychologist |
| LCSW29139 | CA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Camp Glen Rockey | Past | Accepting new patients |
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.
-
- Psychiatric Residential Treatment Facility
- San Dimas, CA
- NPI 1841443918
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1225756800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620000000000",
"number": "1023261005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "550 S VERMONT",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1900 SYCAMORE CANYON RD",
"city": "SAN DIMAS",
"state": "CA",
"postal_code": "91773",
"telephone_number": "909-599-2361"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLAYTON",
"first_name": "KIMBERLY",
"middle_name": "NICOLE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-11-04",
"last_updated": "2021-05-03",
"certification_date": "2021-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCSW29139",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Dimas, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.