Active NPI
Susan Gerdtz, LCSW
- Clinical Social Worker
- Fairfield, CA
National Provider Identifier
1053463166
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW28488
- Practice address
- 801 Empire St
Fairfield, CA 94533-5702 - Phone
- (707) 425-5744
- Fax
- (707) 425-5162
- NPI assigned
- Jan 17, 2007
- 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 | LCSW28488 | CA | Primary |
Addresses
Primary practice location
801 Empire St
Fairfield, CA 94533-5702
Mailing address
2110 Wilmington Dr
Walnut Creek, CA 94596-6239
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3782 | Medicaid | CA |
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 |
|---|---|---|---|
| LCSW28488 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168992000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1488240000000",
"number": "1053463166",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2110 WILMINGTON DR",
"city": "WALNUT CREEK",
"state": "CA",
"postal_code": "945966239"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 EMPIRE ST",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945335702",
"telephone_number": "707-425-5744",
"fax_number": "707-425-5162"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GERDTZ",
"first_name": "SUSAN",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-17",
"last_updated": "2017-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCSW28488",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3782",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairfield, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.