Jan-Kees George Van Der Gaag, MSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW23674 Issued in CA

Practice address

2630 Hollyridge Drive
Los Angeles, CA 90068

Phone

(323) 487-1784

Fax

(310) 423-7169

NPI assigned

Jul 25, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Nov 13, 2023 through Nov 13, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1216944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656979200000",
    "number": "1093970378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2630 HOLLYRIDGE DRIVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90068",
            "telephone_number": "323-487-1784",
            "fax_number": "310-423-7169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2630 HOLLYRIDGE DRIVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90068",
            "telephone_number": "323-487-1784",
            "fax_number": "310-423-7169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DER GAAG",
        "first_name": "JAN-KEES",
        "middle_name": "GEORGE",
        "name_prefix": "Mr.",
        "credential": "MSW, LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-25",
        "last_updated": "2022-07-05",
        "certification_date": "2022-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS23674",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW23674",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Rae Van Buren, M.D.
• Elsie Van Clief
• Jacques Van Dam, M.D., PH.D.
• Kristina Van de Goor, MD
• Kimberly Van de Wetering, P.T.
• Alisha Van Der Linden, NP
• Benjamin Van Der Woerd, MD
• Morgan Van Diepen, BCBA
• Amanda Rae Van Duren, RD
• Richelle Van Dusen

• Clinical Social Worker in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.