Active NPI
Roberta A Verdugo, LCSW
- Clinical Social Worker
- Banning, CA
National Provider Identifier
1457581712
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCS 19036
- Practice address
- 11555 1/2 Potrero Rd.
Banning, CA 92220 - Phone
- (951) 849-4761
- NPI assigned
- Jul 21, 2009
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LCS 19036 | CA | |
| Clinical Social Worker | 1041C0700X | LCS 19036 | CA | Primary |
Addresses
Primary practice location
11555 1/2 Potrero Rd.
Banning, CA 92220
Mailing address
11155 1/2 Potrero Rd,
Banning, CA 92220
Phone (951) 849-4761
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 |
|---|---|---|---|
| LCS 19036 | CA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1248134400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1248134400000",
"number": "1457581712",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11155 1/2 POTRERO RD,",
"city": "BANNING",
"state": "CA",
"postal_code": "92220",
"telephone_number": "951-849-4761"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11555 1/2 POTRERO RD.",
"city": "BANNING",
"state": "CA",
"postal_code": "92220",
"telephone_number": "951-849-4761"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VERDUGO",
"first_name": "ROBERTA",
"middle_name": "A",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-07-21",
"last_updated": "2009-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "LCS 19036",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCS 19036",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Banning, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.