Susan Wright, LCS2139

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2139 Issued in CA

Practice address

311 Prince Royal Dr
Creative Life Change Institute
Corte Madera, CA 94925

Phone

(415) 927-2748

Fax

(415) 927-7948

NPI assigned

Sep 12, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1053415604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 PRINCE ROYAL DR",
            "address_2": "CREATIVE LIFE CHANGE INSTITUTE",
            "city": "CORTE MADERA",
            "state": "CA",
            "postal_code": "94925",
            "telephone_number": "415-927-2748",
            "fax_number": "415-927-7948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 PRINCE ROYAL DR",
            "address_2": "CREATIVE LIFE CHANGE INSTITUTE",
            "city": "CORTE MADERA",
            "state": "CA",
            "postal_code": "94925",
            "telephone_number": "415-927-2748",
            "fax_number": "415-927-7948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WRIGHT",
        "first_name": "SUSAN",
        "name_prefix": "Ms.",
        "credential": "LCS2139",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "2139",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "341654554",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wood Chiropractic, Inc.
• Chappy J Wood, DC
• Ryan Woodring
• Eleanor Rawlings Woodward
• Sarah Wright, AMFT
• Erin Michelle Hisae Yip, PSYD
• Katherine Sophia Yochim, M.S., CCC-SLP
• Christina Young
• Jessy Young, NP
• Julie B Young, DDS

• Clinical Social Worker in Corte Madera, CA
• Providers in Corte Madera, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.

Verify at the official NPI Registry.