Active NPI
Justin M Gay, LCSW
- Clinical Social Worker
- Pueblo, CO
National Provider Identifier
1063978682
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 4401
- Practice address
- 4776 Eagleridge Cir
Pueblo, CO 81008-2189 - Phone
- (719) 584-5183
- Fax
- (719) 584-5496
- NPI assigned
- Feb 19, 2019
- 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 | 4401 | HI | Primary |
Addresses
Primary practice location
4776 Eagleridge Cir
Pueblo, CO 81008-2189
Mailing address
4776 Eagleridge Cir
Pueblo, CO 81008-2189
Phone (719) 584-5183
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4401 | Other | HI | LCSW LICENSURE |
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 |
|---|---|---|---|
| 4401 | HI | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1550534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1550534400000",
"number": "1063978682",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4776 EAGLERIDGE CIR",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810082189",
"telephone_number": "719-584-5183",
"fax_number": "719-584-5496"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4776 EAGLERIDGE CIR",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810082189",
"telephone_number": "719-584-5183",
"fax_number": "719-584-5496"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAY",
"first_name": "JUSTIN",
"middle_name": "M",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-02-19",
"last_updated": "2019-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "HI",
"license": "4401",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LCSW LICENSURE",
"identifier": "4401",
"state": "HI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.