Active NPI
Peter Cobbold Small, LCSW
- Clinical Social Worker
- Vallejo, CA
National Provider Identifier
1154483006
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCS 21547
- Practice address
- 146 Rainier Ave RM 5
Vallejo, CA 94589-1846 - Phone
- (707) 553-5493
- Fax
- (707) 553-5719
- NPI assigned
- Dec 15, 2006
- Sex
- Male
- Sole proprietor
- No
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 | LCS 21547 | CA | Primary |
Addresses
Primary practice location
146 Rainier Ave RM 5
Vallejo, CA 94589-1846
Mailing address
555 Pierce St Apt 1003
Albany, CA 94706-1003
Phone (510) 528-1590
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 |
|---|---|---|---|
| LCS 21547 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166140800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1154483006",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "555 PIERCE ST APT 1003",
"city": "ALBANY",
"state": "CA",
"postal_code": "947061003",
"telephone_number": "510-528-1590"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "146 RAINIER AVE RM 5",
"city": "VALLEJO",
"state": "CA",
"postal_code": "945891846",
"telephone_number": "707-553-5493",
"fax_number": "707-553-5719"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMALL",
"first_name": "PETER",
"middle_name": "COBBOLD",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCS 21547",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vallejo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.