Active NPI
Michael Hodson Street, LCSW
- Clinical Social Worker
- Clearlake, CA
National Provider Identifier
1093872095
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCS 18551
- Practice address
- 7000B S Center Dr
Clearlake, CA 95422-8131 - Phone
- (707) 508-6412
- Fax
- (707) 274-9192
- NPI assigned
- Jan 2, 2007
- Sex
- Male
- Sole proprietor
- No
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 | LCS 18551 | CA | Primary |
Addresses
Primary practice location
7000B S Center Dr
Clearlake, CA 95422-8131
Mailing address
6302 13TH Ave
Lucerne, CA 95458
Phone (707) 274-9101
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCS 18551 | CA | MD | Clinical Social Worker |
| 18551 | CA | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| County of Lake | Past | Accepting new patients | |
| County of Lake | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Lucerne, CA
- NPI 1215140066
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Clearlake, CA
- NPI 1326252271
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1352160000000",
"number": "1093872095",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6302 13TH AVE",
"city": "LUCERNE",
"state": "CA",
"postal_code": "95458",
"telephone_number": "707-274-9101",
"fax_number": "707-274-9192"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7000B S CENTER DR",
"city": "CLEARLAKE",
"state": "CA",
"postal_code": "954228131",
"telephone_number": "707-508-6412",
"fax_number": "707-274-9192"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STREET",
"first_name": "MICHAEL",
"middle_name": "HODSON",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-02",
"last_updated": "2012-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCS 18551",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clearlake, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.