Active NPI
Roy Douglas
- Clinical Social Worker
- Modesto, CA
National Provider Identifier
1407229248
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 1041C0700X.
- Practice address
- 1235 McHerney
A and B
Modesto, CA 95350-9411 - Phone
- (209) 507-5559
- NPI assigned
- Nov 2, 2015
- 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | CA | ||
| Professional Counselor | 101YP2500X | |||
| Case Manager/Care Coordinator | 171M00000X | |||
| Clinical Social Worker | 1041C0700X | 1041C0700X. | CA | Primary |
Addresses
Primary practice location
1235 McHerney
A and B
Modesto, CA 95350-9411
Mailing address
1212 N California St
Stockton, CA 95202-1552
Phone (209) 468-8686
Other practice location 1
1212 N California St
Stockton, CA 95202-1552
Phone (209) 468-8686
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
| License | State | Type | Specialty |
|---|---|---|---|
| 1041C0700X. | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1446422400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704758400000",
"number": "1407229248",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1212 N CALIFORNIA ST",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952021552",
"telephone_number": "209-468-8686"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1235 MCHERNEY",
"address_2": "A AND B",
"city": "MODESTO",
"state": "CA",
"postal_code": "953509411",
"telephone_number": "209-507-5559"
}
],
"practiceLocations": [
{
"address_1": "1212 N California St",
"address_purpose": "LOCATION",
"city": "Stockton",
"state": "CA",
"postal_code": "952021552",
"country_code": "US",
"telephone_number": "209-468-8686",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DOUGLAS",
"first_name": "ROY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-11-02",
"last_updated": "2024-01-09",
"certification_date": "2021-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": null,
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"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": "1041C0700X.",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.