Active NPI
Cary Brannon Clevenger, LCSW
- Clinical Social Worker
- Aliso Viejo, CA
National Provider Identifier
1386938793
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCS19005
- Practice address
- 5 Mareblu
Aliso Viejo, CA 92656-3014 - Phone
- (949) 643-6935
- NPI assigned
- Jun 2, 2011
- Sex
- Male
- Sole proprietor
- No
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 | LCS19005 | CA | Primary |
Addresses
Primary practice location
5 Mareblu
Aliso Viejo, CA 92656-3014
Mailing address
405 W 5TH St Ste 202
Santa Ana, CA 92701-4525
Phone (714) 834-3413
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 |
|---|---|---|---|
| LCS19005 | CA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Teladoc Health Medical Group, P.a. | Clinical | Current | Accepting new patients |
Interoperability endpoints
- caryclevenger@tdh.allscriptsdirect.net
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1306972800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1306972800000",
"number": "1386938793",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "405 W 5TH ST STE 202",
"city": "SANTA ANA",
"state": "CA",
"postal_code": "927014525",
"telephone_number": "714-834-3413"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 MAREBLU",
"city": "ALISO VIEJO",
"state": "CA",
"postal_code": "926563014",
"telephone_number": "949-643-6935"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLEVENGER",
"first_name": "CARY",
"middle_name": "BRANNON",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-06-02",
"last_updated": "2011-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCS19005",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Aliso Viejo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.