Individual provider Active NPI

Mary Ann Raouf Nakhla, ASW

  • Clinical Social Worker
  • San Carlos, CA
National Provider Identifier
1356096465
Registry record updated May 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
122356 Issued in CA
Practice address
610 Elm St
San Carlos, CA 94070-8401
Phone
(650) 591-9623
NPI assigned
Feb 16, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 122356 CA Primary

Addresses

Primary practice location

610 Elm St
San Carlos, CA 94070-8401

Mailing address

610 Elm St
San Carlos, CA 94070-8401
Phone (650) 591-9623

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
122356CAMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1644969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747008000000",
    "number": "1356096465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 ELM ST",
            "city": "SAN CARLOS",
            "state": "CA",
            "postal_code": "940708401",
            "telephone_number": "650-591-9623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 ELM ST",
            "city": "SAN CARLOS",
            "state": "CA",
            "postal_code": "940708401",
            "telephone_number": "650-591-9623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NAKHLA",
        "first_name": "MARY ANN",
        "middle_name": "RAOUF",
        "credential": "ASW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-16",
        "last_updated": "2025-05-12",
        "certification_date": "2025-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "122356",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Carlos, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2025; 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.