Active NPI
Michael Wylie Vurek, LCSW
- Clinical Social Worker
- Corte Madera, CA
National Provider Identifier
1235196171
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCS12882
- Practice address
- 300 Tamal PLZ
Ste 220
Corte Madera, CA 94925-1136 - Phone
- (415) 451-7455
- Fax
- (855) 874-5397
- NPI assigned
- Apr 26, 2006
- Sex
- Male
- 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 | LCS12882 | CA | Primary |
Addresses
Primary practice location
300 Tamal PLZ
Ste 220
Corte Madera, CA 94925-1136
Mailing address
300 Tamal PLZ
Ste 220
Corte Madera, CA 94925-1136
Phone (415) 451-7455
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CSW128820 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2022 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12882 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146009600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1552608000000",
"number": "1235196171",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 TAMAL PLZ",
"address_2": "STE 220",
"city": "CORTE MADERA",
"state": "CA",
"postal_code": "949251136",
"telephone_number": "415-451-7455",
"fax_number": "855-874-5397"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 TAMAL PLZ",
"address_2": "STE 220",
"city": "CORTE MADERA",
"state": "CA",
"postal_code": "949251136",
"telephone_number": "415-451-7455",
"fax_number": "855-874-5397"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VUREK",
"first_name": "MICHAEL",
"middle_name": "WYLIE",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-26",
"last_updated": "2019-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCS12882",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "CSW128820",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Corte Madera, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.