Active NPI
Deborah Raphael, LCSW
- Clinical Social Worker
- Berkeley, CA
National Provider Identifier
1306861117
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCS 6411
- Practice address
- 3555 Dwight Way
Berkeley, CA 94704-2526 - Phone
- (510) 225-5310
- NPI assigned
- Jul 13, 2006
- 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 | LCS 6411 | CA | Primary |
Addresses
Primary practice location
3555 Dwight Way
Berkeley, CA 94704-2526
Mailing address
3555 Dwight Way
Berkeley, CA 94704-2526
Phone (510) 225-5310
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6411 | Other | CA | STATE OF CA LCSW LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 3, 2022 through Mar 3, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCS 6411 | CA | MD | Clinical Social Worker |
| 6411 | CA | MD | Speech-Language Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152748800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1646179200000",
"number": "1306861117",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3555 DWIGHT WAY",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947042526",
"telephone_number": "510-225-5310"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3555 DWIGHT WAY",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947042526",
"telephone_number": "510-225-5310"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAPHAEL",
"first_name": "DEBORAH",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-13",
"last_updated": "2022-03-02",
"certification_date": "2022-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCS 6411",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF CA LCSW LICENSE NUMBER",
"identifier": "6411",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Berkeley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.