Miguel Porcayo

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

113962 Issued in CA

Practice address

2580 Lake Tahoe Blvd Ste D
South Lake Tahoe, CA 96150-7723

Phone

(530) 544-2111

NPI assigned

Jul 5, 2022

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1656979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688515200000",
    "number": "1316670649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2580 LAKE TAHOE BLVD STE D",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961507723",
            "telephone_number": "530-544-2111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2580 LAKE TAHOE BLVD STE D",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961507723",
            "telephone_number": "530-544-2111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORCAYO",
        "first_name": "MIGUEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-05",
        "last_updated": "2023-07-05",
        "certification_date": "2023-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "113962",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christy Petty
• Rebecca K Phillipsen, MSW, LCSW
• Barbara Pidermann, FNP
• Samuel J Pierini, PHARMD
• Kyle Pieters
• Zachary Akio Powers, RPH
• James Jonathan Pratt, MS, ATC, OTC
• Christopher S Proctor, PT
• Peter Protell, MD
• PT Revolution Physical Therapy, PC

• Clinical Social Worker in South Lake Tahoe, CA
• Providers in South Lake Tahoe, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2023; 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.