Individual provider Active NPI

Angelus TW Dupree, MSW, LCSW

  • Clinical Social Worker
  • Sacramento, CA
National Provider Identifier
1093947376
Registry record updated Feb 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
77673 Issued in CA
Practice address
725 30TH St Ste 209
Sacramento, CA 95816-3842
Phone
(916) 884-0607
NPI assigned
Aug 20, 2009
Last updated
Feb 12, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 29148 CA
Mental Health Counselor 101YM0800X 77673 CA
Clinical Social Worker 1041C0700X 77673 CA Primary

Addresses

Primary practice location

725 30TH St Ste 209
Sacramento, CA 95816-3842

Mailing address

8976 Neponset Dr
Elk Grove, CA 95624-3580
Phone (916) 884-0607

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20220218001384 CA Practitioner - Clinical Social Worker 2264826106 Reassigns benefits to 1 organization
Practice locations: Elk Grove, CA

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
77673CAMDMental Health Counselor
29148CAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Criy -Cultivating Resilience in You Therapeutic Services Clinical CurrentSince Jul 1, 2023 Accepting new patients
Sutter Health Sacramento Sierra Region Past Accepting new patients

Locations

725 30th St
Ste 209
Sacramento, CA 95816
Phone (916) 884-0607

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1250726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739318400000",
    "number": "1093947376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8976 NEPONSET DR",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "956243580",
            "telephone_number": "916-884-0607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 30TH ST STE 209",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958163842",
            "telephone_number": "916-884-0607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUPREE",
        "first_name": "ANGELUS",
        "middle_name": "TW",
        "name_prefix": "Mr.",
        "credential": "MSW, LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-20",
        "last_updated": "2025-02-12",
        "certification_date": "2025-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "29148",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "77673",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "77673",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.