Gemma Lara de Blas Williams, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW 26161 Issued in CA

Practice address

17350 Mount Herrmann St
Suite a
Fountain Valley, CA 92708-4114

Phone

(714) 444-3463

Fax

(714) 444-1768

NPI assigned

Aug 1, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Apr 1, 2017 through Apr 1, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• LDS Family Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fountain Valley, CA
  • NPI 1104906098
  NPD (past)

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

{
    "created_epoch": "1185926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312243200000",
    "number": "1124218409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17350 MOUNT HERRMANN ST",
            "address_2": "SUITE A",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927084114",
            "telephone_number": "714-444-3463",
            "fax_number": "714-444-1768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17350 MOUNT HERRMANN ST",
            "address_2": "SUITE A",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927084114",
            "telephone_number": "714-444-3463",
            "fax_number": "714-444-1768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "GEMMA",
        "middle_name": "LARA DE BLAS",
        "name_prefix": "Miss",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-08-01",
        "last_updated": "2011-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "ASW 22065",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "CSW 6608769-3502",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW 26161",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Hague Inc
• William I. Han, M.D. Inc
• William M. Young, M.D. a Medical Corporation
• Colleen Patricia Williams, MA, BCBA LBA
• Erin Williams, RBT
• Madeline Zola Williams
• Megan Courtney Williams, NONE
• Randal Reginald Williams
• Patrick W Willson, OT
• Cole Jordan Wilsie, PTA

• Clinical Social Worker in Fountain Valley, CA
• Providers in Fountain Valley, 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 Aug 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.