Active NPI
Dan Gary Wertheimer, LICSW
- Clinical Social Worker
- Alameda, CA
National Provider Identifier
1104062405
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 110136
- Practice address
- 1901 Shoreline Drive
Apt 303
Alameda, CA 94510 - Phone
- (510) 995-8971
- NPI assigned
- Dec 17, 2008
- 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 | 110136 | MA | Primary |
Addresses
Primary practice location
1901 Shoreline Drive
Apt 303
Alameda, CA 94510
Mailing address
1901 Shoreline Dr
Apt. 303
Alameda, CA 94501-6067
Phone (510) 995-8971
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 |
|---|---|---|---|
| 110136 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1229472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1229472000000",
"number": "1104062405",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1901 SHORELINE DR",
"address_2": "APT. 303",
"city": "ALAMEDA",
"state": "CA",
"postal_code": "945016067",
"telephone_number": "510-995-8971"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1901 SHORELINE DRIVE",
"address_2": "APT 303",
"city": "ALAMEDA",
"state": "CA",
"postal_code": "94510",
"telephone_number": "510-995-8971"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WERTHEIMER",
"first_name": "DAN",
"middle_name": "GARY",
"name_prefix": "Mr.",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-12-17",
"last_updated": "2008-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "110136",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Alameda, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.