Active NPI
Rene Suzanne De Luca, LCSW
- Clinical Social Worker
- San Diego, CA
National Provider Identifier
1205904406
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 104311
- Practice address
- 3491 Kurtz St Ste 150
San Diego, CA 92110-4430 - Phone
- (619) 320-2404
- NPI assigned
- Dec 4, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 0904004872 | VA | |
| Clinical Social Worker | 1041C0700X | 104311 | CA | Primary |
Addresses
Primary practice location
3491 Kurtz St Ste 150
San Diego, CA 92110-4430
Mailing address
3491 Kurtz St Ste 150
San Diego, CA 92110-4430
Phone (619) 320-2404
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 466286 | Other | VA | BLUE CROSS BLUE SHIELD |
| 4945247 | Medicaid | VA |
Other names 1
- Ms. Renee Berry
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 104311 | CA | MD | Clinical Social Worker |
| 0904004872 | VA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prince William County | Past | Accepting new patients | |
| Prince William County Community Services Board | 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.
-
- Ambulance
- Prince William, VA
- NPI 1235437385
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Manassas, VA
- NPI 1053402800
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1645056000000",
"number": "1205904406",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3491 KURTZ ST STE 150",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921104430",
"telephone_number": "619-320-2404"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3491 KURTZ ST STE 150",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921104430",
"telephone_number": "619-320-2404"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DE LUCA",
"first_name": "RENE",
"middle_name": "SUZANNE",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-04",
"last_updated": "2022-02-17",
"certification_date": "2022-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "VA",
"license": "0904004872",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "104311",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "466286",
"state": "VA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4945247",
"state": "VA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "RENEE",
"last_name": "BERRY",
"prefix": "MS.",
"code": "1",
"type": "Former Name"
}
]
}
Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.