Active NPI
Sandra Lee Perez, LCSW
- Clinical Social Worker
- Modesto, CA
National Provider Identifier
1154656908
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCS15520
- Practice address
- 1510 Florida Ave
Suite H
Modesto, CA 95350-4437 - Phone
- (209) 574-1030
- Fax
- (209) 574-1038
- NPI assigned
- Oct 13, 2009
- Sex
- Female
- 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 | LCS15520 | CA | Primary |
Addresses
Primary practice location
1510 Florida Ave
Suite H
Modesto, CA 95350-4437
Mailing address
737 W Childs Ave
Merced, CA 95341-6805
Phone (209) 383-1848
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LCS15520 | Other | CA | MEDICAL LICENSE |
Other names 1
- Sandra Lee Harris
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCS15520 | CA | MD | Clinical Social Worker |
| 15520 | CA | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Golden Valley Health Center | Past | Accepting new patients | |
| Golden Valley Health Center | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Federally Qualified Health Center (FQHC)
- Modesto, CA
- NPI 1336123926
-
- Federally Qualified Health Center (FQHC)
- Modesto, CA
- NPI 1487867503
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1255392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1326326400000",
"number": "1154656908",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "737 W CHILDS AVE",
"city": "MERCED",
"state": "CA",
"postal_code": "953416805",
"telephone_number": "209-383-1848",
"fax_number": "209-383-1296"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1510 FLORIDA AVE",
"address_2": "SUITE H",
"city": "MODESTO",
"state": "CA",
"postal_code": "953504437",
"telephone_number": "209-574-1030",
"fax_number": "209-574-1038"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEREZ",
"first_name": "SANDRA",
"middle_name": "LEE",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-10-13",
"last_updated": "2012-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCS15520",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL LICENSE",
"identifier": "LCS15520",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "SANDRA",
"last_name": "HARRIS",
"middle_name": "LEE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.