Individual provider Active NPI

Amenze O. Ogbebor, LCSW

  • Clinical Social Worker
  • Riverside, CA
National Provider Identifier
1285763318
Registry record updated Jun 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW28472 Issued in CA
Practice address
2085 Rustin Ave Ste 1109
Riverside, CA 92507-2498
Phone
(951) 955-6249
Fax
(951) 955-7220
NPI assigned
Mar 5, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 28, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LCSW28472 CA Primary

Addresses

Primary practice location

2085 Rustin Ave Ste 1109
Riverside, CA 92507-2498

Mailing address

2085 Rustin Ave Ste 1109
Riverside, CA 92507-2498
Phone (951) 955-6249

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

State licenses

LicenseStateTypeSpecialty
LCSW28472CAMDClinical Social Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624838400000",
    "number": "1285763318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2085 RUSTIN AVE STE 1109",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925072498",
            "telephone_number": "951-955-6249",
            "fax_number": "951-955-7220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2085 RUSTIN AVE STE 1109",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925072498",
            "telephone_number": "951-955-6249",
            "fax_number": "951-955-7220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OGBEBOR",
        "first_name": "AMENZE",
        "middle_name": "O.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-05",
        "last_updated": "2021-06-28",
        "certification_date": "2021-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW28472",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 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.

Verify at the official NPI Registry.