Individual provider Active NPI

George A. Suiter, PSYD/LCSW

  • Clinical Social Worker
  • San Diego, CA
National Provider Identifier
1124035563
Registry record updated Nov 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
83452 Issued in CA
Practice address
12486 Rios Rd
San Diego, CA 92128-2841
Phone
(858) 217-7083
Fax
(619) 326-8952
NPI assigned
Aug 1, 2006
Last updated
Nov 1, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 1, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychoanalysis Psychologist 103TP0814X
Clinical Social Worker 1041C0700X 1039 OK
Clinical Social Worker 1041C0700X 83452 CA Primary

Addresses

Primary practice location

12486 Rios Rd
San Diego, CA 92128-2841

Mailing address

12486 Rios Rd
San Diego, CA 92128-2841
Phone (858) 217-7083

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
I20201204001122 CA Practitioner - Clinical Social Worker 0244380053

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4618 Marlborough Dr
San Diego, CA 92116-4711

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1039OKMDAddiction (Substance Use Disorder) Counselor

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, 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": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730419200000",
    "number": "1124035563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12486 RIOS RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921282841",
            "telephone_number": "858-217-7083",
            "fax_number": "619-326-8952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12486 RIOS RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921282841",
            "telephone_number": "858-217-7083",
            "fax_number": "619-326-8952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUITER",
        "first_name": "GEORGE",
        "middle_name": "A.",
        "credential": "PSYD/LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2024-11-01",
        "certification_date": "2024-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TP0814X",
            "taxonomy_group": "",
            "desc": "Psychologist, Psychoanalysis",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OK",
            "license": "1039",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "83452",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.