Active NPI
Maatisak Amenhetep Gipson, L.C.S.W.
- Clinical Social Worker
- Rio Linda, CA
National Provider Identifier
1417067463
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCS19290
- Practice address
- 6900 2ND Street
Rio Linda, CA 95673 - Phone
- (951) 564-6715
- Fax
- (916) 457-2667
- NPI assigned
- Aug 30, 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 | LCS19290 | CA | Primary |
Addresses
Primary practice location
6900 2ND Street
Rio Linda, CA 95673
Mailing address
1200 Garaventa Way
Sacramento, CA 95833
Phone (951) 564-6715
Other names 1
- Maatisak Sauat Nera Amenhetep
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 |
|---|---|---|---|
| LCS19290 | CA | MD | Clinical Social Worker |
| 19290 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687132800000",
"number": "1417067463",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 GARAVENTA WAY",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "95833",
"telephone_number": "951-564-6715",
"fax_number": "916-457-2667"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6900 2ND STREET",
"city": "RIO LINDA",
"state": "CA",
"postal_code": "95673",
"telephone_number": "951-564-6715",
"fax_number": "916-457-2667"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIPSON",
"first_name": "MAATISAK",
"middle_name": "AMENHETEP",
"name_prefix": "Ms.",
"credential": "L.C.S.W.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-30",
"last_updated": "2023-06-19",
"certification_date": "2023-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCS19290",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MAATISAK",
"last_name": "AMENHETEP",
"middle_name": "SAUAT NERA",
"credential": "L.C.S.W.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Rio Linda, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.