NPIMap

Organization Active NPI

Stanislaus County

  • Clinical Social Worker
  • Modesto, CA
National Provider Identifier
1174724884
Registry record updated Oct 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
STANISLAUS COUNTY
Practice address
800 Scenic Dr
Modesto, CA 95350-6131
Phone
(209) 558-4752
NPI assigned
May 30, 2007
Last updated
Oct 11, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
COUNTY OF STANISLAUSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 11, 2019

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

Authorized official

Name
Ruben Imperial, MBA
Title
Behavioral Health Interim Director
Phone
(209) 525-6225

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X Primary

Addresses

Primary practice location

800 Scenic Dr
Modesto, CA 95350-6131

Mailing address

800 Scenic Dr
Modesto, CA 95350-6131

Other identifiers 1

IdentifierTypeStateIssuer
5056MedicaidCA

Other names 1

  • FEE FOR SERVICE - LCSW Other name

National Provider Directory

National Provider Directory
Tax ID family
Stan Co Mentalhealth SV114 organizations share this tax ID, including this one
Part of
Stan Co Mentalhealth SV

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570752000000",
    "number": "1174724884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 SCENIC DR",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953506131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 SCENIC DR",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953506131",
            "telephone_number": "209-558-4752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STANISLAUS COUNTY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COUNTY OF STANISLAUS",
        "enumeration_date": "2007-05-30",
        "last_updated": "2019-10-11",
        "status": "A",
        "authorized_official_last_name": "IMPERIAL",
        "authorized_official_first_name": "RUBEN",
        "authorized_official_title_or_position": "BEHAVIORAL HEALTH INTERIM DIRECTOR",
        "authorized_official_telephone_number": "209-525-6225",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5056",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FEE FOR SERVICE - LCSW",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "FEE FOR SERVICE - LCSW",
            "code": "5",
            "type": "Other 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 Oct 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.