Active NPI
Douglas William Vertin, L.C.S.W.
- Clinical Social Worker
- Cupertino, CA
National Provider Identifier
1275694382
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCS 21071
- Practice address
- 19000 Homestead Rd
Building 2
Cupertino, CA 95014 - Phone
- (408) 366-4413
- NPI assigned
- Dec 12, 2006
- Sex
- Male
- Sole proprietor
- No
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 | LCS 21071 | CA | Primary |
Addresses
Primary practice location
19000 Homestead Rd
Building 2
Cupertino, CA 95014
Mailing address
19000 Homestead Rd
Cupertino, CA 95014
Phone (408) 366-4413
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCS 21071 | CA | MD | Clinical Social Worker |
| 21071 | CA | MD | Orthopedic Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1275694382",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19000 HOMESTEAD RD",
"city": "CUPERTINO",
"state": "CA",
"postal_code": "95014",
"telephone_number": "408-366-4413"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19000 HOMESTEAD RD",
"address_2": "BUILDING 2",
"city": "CUPERTINO",
"state": "CA",
"postal_code": "95014",
"telephone_number": "408-366-4413"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VERTIN",
"first_name": "DOUGLAS",
"middle_name": "WILLIAM",
"name_prefix": "Mr.",
"credential": "L.C.S.W.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCS 21071",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cupertino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.