Active NPI
Rachael Elizabeth Gardiner Wilson, JD, LCSW
- Clinical Social Worker
- Berkeley, CA
National Provider Identifier
1235508367
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 82817
- Practice address
- 1709 Shattuck Ave
Berkeley, CA 94709-1768 - Phone
- (510) 545-6508
- NPI assigned
- Sep 18, 2015
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | CA | ||
| Clinical Social Worker | 1041C0700X | 82817 | CA | Primary |
Addresses
Primary practice location
1709 Shattuck Ave
Berkeley, CA 94709-1768
Mailing address
1831 Solano Ave Unit 7445
Berkeley, CA 94707-5023
Phone (510) 545-6508
Other practice location 1
525 21st St
Oakland, CA 94612-1605
Phone (510) 587-3417
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | rachael@rachaelwilsontherapy.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Juris Doctor
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 82817 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610496000000",
"number": "1235508367",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1831 SOLANO AVE UNIT 7445",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947075023",
"telephone_number": "510-545-6508"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1709 SHATTUCK AVE",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947091768",
"telephone_number": "510-545-6508"
}
],
"practiceLocations": [
{
"address_1": "525 21st St",
"address_purpose": "LOCATION",
"city": "Oakland",
"state": "CA",
"postal_code": "946121605",
"country_code": "US",
"telephone_number": "510-587-3417",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WILSON",
"first_name": "RACHAEL",
"middle_name": "ELIZABETH GARDINER",
"credential": "JD, LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-09-18",
"last_updated": "2021-01-13",
"certification_date": "2021-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "82817",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "rachael@rachaelwilsontherapy.com",
"affiliation": "N",
"endpointDescription": "professional email",
"address_1": "1709 Shattuck Ave",
"city": "Berkeley",
"state": "CA",
"country_code": "US",
"postal_code": "947091768",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Berkeley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.