Individual provider Active NPI

Gwen Marlatt Vela, LCSW

  • Clinical Social Worker
  • Ocean, NJ
National Provider Identifier
1154722593
Registry record updated Sep 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
44SC05484100 Issued in NJ
Practice address
1316 Opdyke Ave
Ocean, NJ 07712-4646
Phone
(908) 902-1356
Fax
(732) 807-3088
NPI assigned
Sep 4, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 4, 2014

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 44SC05484100 NJ Primary

Addresses

Primary practice location

1316 Opdyke Ave
Ocean, NJ 07712-4646

Mailing address

1316 Opdyke Ave
Ocean, NJ 07712-4646
Phone (908) 902-1356

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective Apr 1, 2023 through Apr 1, 2027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
44SC05484100NJMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1409788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409788800000",
    "number": "1154722593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1316 OPDYKE AVE",
            "city": "OCEAN",
            "state": "NJ",
            "postal_code": "077124646",
            "telephone_number": "908-902-1356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1316 OPDYKE AVE",
            "city": "OCEAN",
            "state": "NJ",
            "postal_code": "077124646",
            "telephone_number": "908-902-1356",
            "fax_number": "732-807-3088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VELA",
        "first_name": "GWEN",
        "middle_name": "MARLATT",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-09-04",
        "last_updated": "2014-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC05484100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ocean, NJ

Sources for this page

Verify at the official NPI Registry.