Individual provider Active NPI

Virginia A. Powell, MSW, LCSW, BCD

  • Clinical Social Worker
  • San Diego, CA
National Provider Identifier
1104981323
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCS6790 Issued in CA
Practice address
430 Nutmeg St
Suite C
San Diego, CA 92103-6260
Phone
(619) 291-9108
Fax
(619) 697-5627
NPI assigned
Dec 27, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LCS6790 CA Primary

Addresses

Primary practice location

430 Nutmeg St
Suite C
San Diego, CA 92103-6260

Mailing address

430 Nutmeg St
Suite C
San Diego, CA 92103-6260
Phone (619) 291-9108

Other identifiers 1

IdentifierTypeStateIssuer
0740834MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCS6790CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Olbo Inc PastSince May 7, 2023 Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104981323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 NUTMEG ST",
            "address_2": "SUITE C",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921036260",
            "telephone_number": "619-291-9108",
            "fax_number": "619-697-5627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 NUTMEG ST",
            "address_2": "SUITE C",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921036260",
            "telephone_number": "619-291-9108",
            "fax_number": "619-697-5627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POWELL",
        "first_name": "VIRGINIA",
        "middle_name": "A.",
        "credential": "MSW, LCSW, BCD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS6790",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0740834",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.