NPIMap

Organization Active NPI

Paula Kettula Licensed Clinical Social Worker, Inc.

  • Clinical Social Worker
  • San Diego, CA
National Provider Identifier
1417513458
Registry record updated May 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
PAULA KETTULA LICENSED CLINICAL SOCIAL WORKER, INC.
Practice address
1855 1St Ave Ste 103
San Diego, CA 92101-2650
Phone
(619) 577-5057
Fax
(619) 324-1023
NPI assigned
May 15, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Paula Kettula, LCSWNPI 1073745667
Title
President
Phone
(619) 577-5057

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

1855 1St Ave Ste 103
San Diego, CA 92101-2650

Mailing address

1855 1St Ave Ste 103
San Diego, CA 92101-2650
Phone (619) 577-5057

Other names 1

  • Porta Verum Psychotherapy Services Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address p.kettula.lcsw@medofficemail.com Direct

National Provider Directory

National Provider Directory

Locations

3911 5th Ave
Ste 208
San Diego, CA 92103
Phone (619) 324-1023

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1557878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557878400000",
    "number": "1417513458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1855 1ST AVE STE 103",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921012650",
            "telephone_number": "619-577-5057",
            "fax_number": "619-324-1023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1855 1ST AVE STE 103",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921012650",
            "telephone_number": "619-577-5057",
            "fax_number": "619-324-1023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAULA KETTULA LICENSED CLINICAL SOCIAL WORKER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-15",
        "last_updated": "2019-05-15",
        "status": "A",
        "authorized_official_last_name": "KETTULA",
        "authorized_official_first_name": "PAULA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "619-577-5057",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "p.kettula.lcsw@medofficemail.com",
            "affiliation": "N",
            "endpointDescription": "HIPAA secure email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1855 1st Ave Ste 103",
            "city": "San Diego",
            "state": "CA",
            "country_code": "US",
            "postal_code": "921012650",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Porta Verum Psychotherapy Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.