Active NPI
Gabrielle Banathy-Sullivan, LCSW
- Clinical Social Worker
- Chico, CA
National Provider Identifier
1053925057
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW116292
- Practice address
- 580 Manzanita Ave Ste 5
Chico, CA 95926-1338 - Phone
- (530) 206-0577
- NPI assigned
- Sep 7, 2020
- 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 | LCSW116292 | CA | Primary |
Addresses
Primary practice location
580 Manzanita Ave Ste 5
Chico, CA 95926-1338
Mailing address
1380 East Ave
Suite 124 #115
Chico, CA 95926
Phone (530) 206-0577
Other practice location 1
572 Rio Lindo Ave
Chico, CA 95926-1851
Phone (530) 891-4400
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 |
|---|---|---|---|
| LCSW116292 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1599436800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695686400000",
"number": "1053925057",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1380 EAST AVE",
"address_2": "SUITE 124 #115",
"city": "CHICO",
"state": "CA",
"postal_code": "95926",
"telephone_number": "530-206-0577"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "580 MANZANITA AVE STE 5",
"city": "CHICO",
"state": "CA",
"postal_code": "959261338",
"telephone_number": "530-206-0577"
}
],
"practiceLocations": [
{
"address_1": "572 Rio Lindo Ave",
"address_purpose": "LOCATION",
"city": "Chico",
"state": "CA",
"postal_code": "959261851",
"country_code": "US",
"telephone_number": "530-891-4400",
"fax_number": "530-636-4772",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BANATHY-SULLIVAN",
"first_name": "GABRIELLE",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-09-07",
"last_updated": "2023-09-26",
"certification_date": "2023-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCSW116292",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chico, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.