Active NPI
Deborah Vandenboom, LCSW
- Clinical Social Worker
- Upland, CA
National Provider Identifier
1164509758
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCS23358
- Practice address
- 600 N Mountain Ave Ste C205I
Upland, CA 91786-4359 - Phone
- (909) 377-2616
- NPI assigned
- Nov 1, 2006
- Last updated
- Jul 21, 2022
- Sex
- Female
- Sole proprietor
- Yes
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 | LCS23358 | CA | Primary |
Addresses
Primary practice location
600 N Mountain Ave Ste C205I
Upland, CA 91786-4359
Mailing address
PO Box 2026
Upland, CA 91785-2026
Phone (909) 377-2616
Other practice location 1
1800 Medical Center Dr
Suite 300
San Bernardino, CA 92411-1218
Phone (909) 887-6222
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170911002733 | CA | Practitioner - Clinical Social Worker | 5698878130 | Practice locations: Upland, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
600 N Mountain Ave
205I
Upland, CA 91786-4359
Phone (909) 377-2616
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCS23358 | CA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Deborah Vandenboom | Clinical | Past | Accepting new patients |
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": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1164509758",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2026",
"city": "UPLAND",
"state": "CA",
"postal_code": "917852026",
"telephone_number": "909-377-2616"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 N MOUNTAIN AVE STE C205I",
"city": "UPLAND",
"state": "CA",
"postal_code": "917864359",
"telephone_number": "909-377-2616"
}
],
"practiceLocations": [
{
"address_1": "1800 Medical Center Dr",
"address_2": "Suite 300",
"address_purpose": "LOCATION",
"city": "San Bernardino",
"state": "CA",
"postal_code": "924111218",
"country_code": "US",
"telephone_number": "909-887-6222",
"fax_number": "909-887-4565",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "VANDENBOOM",
"first_name": "DEBORAH",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-01",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCS23358",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Upland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.