Active NPI
Cynthia Bourgeau, LCSW
- Clinical Social Worker
- Klamath Falls, OR
National Provider Identifier
1366513616
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- L1874
- Practice address
- 325 S 5TH St
Klamath Falls, OR 97601-6107 - Phone
- (541) 882-7111
- Fax
- (541) 882-7111
- NPI assigned
- Nov 10, 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 | L1874 | OR | Primary |
Addresses
Primary practice location
325 S 5TH St
Klamath Falls, OR 97601-6107
Mailing address
325 S 5TH St
Klamath Falls, OR 97601-6107
Phone (541) 882-7111
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 021872000 | Other | OR | RBCBS |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L1874 | OR | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163116800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1369267200000",
"number": "1366513616",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "325 S 5TH ST",
"city": "KLAMATH FALLS",
"state": "OR",
"postal_code": "976016107",
"telephone_number": "541-882-7111",
"fax_number": "541-882-7111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "325 S 5TH ST",
"city": "KLAMATH FALLS",
"state": "OR",
"postal_code": "976016107",
"telephone_number": "541-882-7111",
"fax_number": "541-882-7111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOURGEAU",
"first_name": "CYNTHIA",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-10",
"last_updated": "2013-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OR",
"license": "L1874",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RBCBS",
"identifier": "021872000",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Klamath Falls, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.