Active NPI
Emily Rose Sebald, LCSW
- Clinical Social Worker
- Twentynine Palms, CA
National Provider Identifier
1417334384
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 88142
- Practice address
- 1145 Sturgis Rd.
Twentynine Palms, CA 92278 - Phone
- (760) 830-2752
- NPI assigned
- Apr 29, 2015
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 88142 | CA | Primary |
| Mental Health Counselor | 101YM0800X | 72195 | CA |
Addresses
Primary practice location
1145 Sturgis Rd.
Twentynine Palms, CA 92278
Mailing address
3105 Upshur Ave Apt D
Twentynine Palms, CA 92277-9459
Phone (858) 223-7105
Other practice location 1
9445 Farnham St
Ste. 100
San Diego, CA 92123-1308
Phone (858) 380-4676
Other practice location 2
3665 Kearny Villa Rd Ste 101
San Diego, CA 92123-1954
Phone (858) 966-5832
Other names 1
- Miss Emily Rose Mohamed
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 |
|---|---|---|---|
| 72195 | CA | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1430265600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1612137600000",
"number": "1417334384",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3105 UPSHUR AVE APT D",
"city": "TWENTYNINE PALMS",
"state": "CA",
"postal_code": "922779459",
"telephone_number": "858-223-7105",
"fax_number": "858-223-7109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1145 STURGIS RD.",
"city": "TWENTYNINE PALMS",
"state": "CA",
"postal_code": "92278",
"telephone_number": "760-830-2752"
}
],
"practiceLocations": [
{
"address_1": "9445 Farnham St",
"address_2": "Ste. 100",
"address_purpose": "LOCATION",
"city": "San Diego",
"state": "CA",
"postal_code": "921231308",
"country_code": "US",
"telephone_number": "858-380-4676",
"fax_number": "858-569-1873",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3665 Kearny Villa Rd Ste 101",
"address_purpose": "LOCATION",
"city": "San Diego",
"state": "CA",
"postal_code": "921231954",
"country_code": "US",
"telephone_number": "858-966-5832",
"fax_number": "858-966-6733",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SEBALD",
"first_name": "EMILY",
"middle_name": "ROSE",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-04-29",
"last_updated": "2021-02-01",
"certification_date": "2021-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "88142",
"primary": true
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "72195",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "EMILY",
"last_name": "MOHAMED",
"middle_name": "ROSE",
"prefix": "MISS",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Twentynine Palms, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.