Active NPI
Jill E. Bertelli, L.C.S.W.
- Clinical Social Worker
- Crestline, CA
National Provider Identifier
1306027792
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 23603
- Practice address
- 692 Chateau Dr.
Crestline, CA 92325-0513 - Phone
- (909) 496-6876
- NPI assigned
- Nov 14, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 23603 | CA | Primary |
Addresses
Primary practice location
692 Chateau Dr.
Crestline, CA 92325-0513
Mailing address
PO Box 513
Crestline, CA 92325-0513
Phone (909) 496-6876
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1194998400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1194998400000",
"number": "1306027792",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 513",
"city": "CRESTLINE",
"state": "CA",
"postal_code": "923250513",
"telephone_number": "909-496-6876"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "692 CHATEAU DR.",
"city": "CRESTLINE",
"state": "CA",
"postal_code": "923250513",
"telephone_number": "909-496-6876"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERTELLI",
"first_name": "JILL",
"middle_name": "E.",
"name_prefix": "Ms.",
"credential": "L.C.S.W.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-11-14",
"last_updated": "2007-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "23603",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Crestline, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 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.