Individual provider Active NPI

Maitreya Deva Rosiles, LCSW

  • Clinical Social Worker
  • Santa Clara, CA
National Provider Identifier
1235565516
Registry record updated Jan 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
103511 Issued in CA
Practice address
5201 Great America Pkwy Ste 320
Santa Clara, CA 95054-1140
Phone
(323) 205-7088
NPI assigned
Sep 19, 2013
Last updated
Jan 23, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 103511 CA Primary
Case Manager/Care Coordinator 171M00000X

Addresses

Primary practice location

5201 Great America Pkwy Ste 320
Santa Clara, CA 95054-1140

Mailing address

3462 Richmond Blvd
Oakland, CA 94611-5820
Phone (619) 362-6980

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211203000073 CA Practitioner - Clinical Social Worker 4082004148 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Bay Area Community Services, Inc. Current Accepting new patients
Bay Area Community Services, Inc. Mental Health CurrentSince Aug 25, 2021 Accepting new patients
Bay Area Community Services, Inc. CurrentSince Aug 25, 2021 Accepting new patients
Brighter Beginnings PastSince Jan 1, 2021 Accepting new patients

Locations

390 40th St
Oakland, CA 94609
Phone (510) 247-8235

559 16th St
Oakland, CA 94612
Phone (510) 318-6112

Organizations & group practices 4

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": "1379548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705968000000",
    "number": "1235565516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3462 RICHMOND BLVD",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946115820",
            "telephone_number": "619-362-6980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5201 GREAT AMERICA PKWY STE 320",
            "city": "SANTA CLARA",
            "state": "CA",
            "postal_code": "950541140",
            "telephone_number": "323-205-7088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSILES",
        "first_name": "MAITREYA",
        "middle_name": "DEVA",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-19",
        "last_updated": "2024-01-23",
        "certification_date": "2024-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "103511",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Clara, CA

Sources for this page

Verify at the official NPI Registry.