Kristen Denise White-Madsen, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

81734 Issued in CA

Practice address

3607 Blaker Rd
Ceres, CA 95307-9503

Phone

(209) 531-2088

NPI assigned

Jul 10, 2007

Reactivated

Mar 8, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• San Joaquin Behavioral Health Services

  • Community/Behavioral Health Agency
  • Stockton, CA
  • NPI 1215028931

  CA, Mental Health

  Medicare reassignment NPD
• Mood Clinical, P. C.

  • Adult Mental Health Clinic/Center
  • Santa Ana, CA
  • NPI 1922675644

  CA

  Medicare reassignment
• County of San Joaquin

  • Multi-Specialty Clinic/Center
  • Manteca, CA
  • NPI 1417407636
  NPD
• Elite Family Systems

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Ceres, CA
  • NPI 1679153142
  NPD
• Elite Family Systems - Blaker Home

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Ceres, CA
  • NPI 1891375366
  NPD
• San Joaquin County Public Health Services

  • Public Health or Welfare Agency
  • Stockton, CA
  • NPI 1356453831
  NPD
• Elite Family Systems

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Ceres, CA
  • NPI 1285214759
  NPD (past)
• Elite Family Systems

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Ceres, CA
  • NPI 1346820818
  NPD (past)
• Elite Family Systems

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Ceres, CA
  • NPI 1467032938
  NPD (past)
• Manuch Inc.

  • Mental Illness Community Based Residential Treatment Facility
  • Fresno, CA
  • NPI 1033727326
  NPD (past)

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

{
    "created_epoch": "1184025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690761600000",
    "number": "1295933380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1708 BANYAN CT",
            "city": "CERES",
            "state": "CA",
            "postal_code": "953071907",
            "telephone_number": "095-312-0882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3607 BLAKER RD",
            "city": "CERES",
            "state": "CA",
            "postal_code": "953079503",
            "telephone_number": "209-531-2088"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1708 Banyan Ct",
            "address_purpose": "LOCATION",
            "city": "Ceres",
            "state": "CA",
            "postal_code": "953071907",
            "country_code": "US",
            "telephone_number": "209-531-2088",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3212 Uranus Dr",
            "address_purpose": "LOCATION",
            "city": "Ceres",
            "state": "CA",
            "postal_code": "953073010",
            "country_code": "US",
            "telephone_number": "209-531-2088",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2528 Leslie Ln",
            "address_purpose": "LOCATION",
            "city": "Ceres",
            "state": "CA",
            "postal_code": "953072326",
            "country_code": "US",
            "telephone_number": "203-531-2088",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WHITE-MADSEN",
        "first_name": "KRISTEN",
        "middle_name": "DENISE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-10",
        "last_updated": "2023-07-31",
        "certification_date": "2023-07-31",
        "deactivation_date": "2018-03-02",
        "reactivation_date": "2018-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "ASW31516",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW81734",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "81734",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Ceres, CA
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.