Sally Lynn Dutton, LCSW
Individual provider Active NPI Clinical Social Worker · Grover Beach, CA
NPI 1104255298 · NPPES record last updated Aug 29, 2023
Key facts
- NPI
- 1104255298
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- LCSW76565 (CA)
- Practice address
- 940 Ramona Ave Ste J
Grover Beach, CA 93433-2155 - Phone
- (805) 994-9914
- NPI assigned
- Nov 8, 2013
- Sex
- Female
- Sole proprietor
- Yes
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
940 Ramona Ave
Suite J
Grover Beach, CA 93433-2155
Phone (805) 994-9914
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171212001913 | CA | Practitioner - Clinical Social Worker | 1557629946 | Practice locations: Grover Beach, CA |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW76565 | CA | MD | Clinical Social Worker |
| 76565 | CA | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCSW76565 | CA | Yes |
Addresses
Primary practice location
940 Ramona Ave Ste J
Grover Beach, CA 93433-2155
Mailing address
PO Box 927
Nipomo, CA 93444-0927
Phone (805) 994-9914
Other names
- Sally Lynn Miller
Other providers in Grover Beach, CA
- Kristen Deuel
- Stephanie Diaz
- Lindsay Doerner
- Camila Dos Santos de Souza
- Nicole Marina Drake
- Kristin Marie Edler
- Theresa Epperson
- Cheri K Ermshar
- Glen Eric Fairfield
- Samatha Flores
All providers in Grover Beach, CA · Clinical Social Worker in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 29, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.