Ly Lan Marie Vo Lofgren, LICENSED CLINICAL SO

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

23998 Issued in CA

Practice address

1411 Marsh Street Ste 105
San Luis Obispo, CA 93401

Phone

(805) 748-8427

NPI assigned

Dec 3, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jan 1, 2017 through Jan 1, 2027

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1196640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591488000000",
    "number": "1336321397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5402",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934035402",
            "telephone_number": "805-762-4598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1411 MARSH STREET STE 105",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "93401",
            "telephone_number": "805-748-8427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOFGREN",
        "first_name": "LY LAN",
        "middle_name": "MARIE VO",
        "credential": "LICENSED CLINICAL SO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-12-03",
        "last_updated": "2020-06-07",
        "certification_date": "2020-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "23998",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeff Michael Lloyd, LPT
• Wanda L Lo, M.D.
• Claire Lockwood, RN
• Brittany M Loe, MA, OTR/L
• Julie Y Loe, MA, ECSE
• Megan Lomax, R.D.
• Karolyn Lavonne London, PSYCHIATRIC TECHNICI
• Robin Rachelle London
• Kathleen Long, L.AC
• Kathleen L Long, M.D.

• Clinical Social Worker in San Luis Obispo, CA
• Providers in San Luis Obispo, 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 Jun 7, 2020; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.