Active NPI
Gautam Roman Gupta, LCSW
- Clinical Social Worker
- North Hills, CA
National Provider Identifier
1033414263
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 71537
- Practice address
- 15305 Rayen St
North Hills, CA 91343-5117 - Phone
- (818) 277-2600
- NPI assigned
- Jan 19, 2011
- Sex
- Male
- 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 | 71537 | CA | Primary |
Addresses
Primary practice location
15305 Rayen St
North Hills, CA 91343-5117
Mailing address
15305 Rayen St
North Hills, CA 91343-5117
Phone (818) 277-2600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 95-2633765 | Other | CA | MEDI-CAL |
Other names 1
- Roman Gupta
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
| License | State | Type | Specialty |
|---|---|---|---|
| 71537 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1295395200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1466553600000",
"number": "1033414263",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15305 RAYEN ST",
"city": "NORTH HILLS",
"state": "CA",
"postal_code": "913435117",
"telephone_number": "818-277-2600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15305 RAYEN ST",
"city": "NORTH HILLS",
"state": "CA",
"postal_code": "913435117",
"telephone_number": "818-277-2600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUPTA",
"first_name": "GAUTAM",
"middle_name": "ROMAN",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-01-19",
"last_updated": "2016-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "71537",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDI-CAL",
"identifier": "95-2633765",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "ROMAN",
"last_name": "GUPTA",
"credential": "LCSW",
"code": "5",
"type": "Other Name"
}
]
}Other providers in North Hills, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.