Active NPI
Gwendolyn Harville Washington, LCSW
- Clinical Social Worker
- Rancho Cucamonga, CA
National Provider Identifier
1467509968
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCS 22188
- Practice address
- 9089 Baseline Rd
Suite 200
Rancho Cucamonga, CA 91730-1295 - Phone
- (909) 210-5895
- Fax
- (909) 989-3932
- NPI assigned
- Jan 5, 2007
- 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 | LCS 22188 | CA | Primary |
Addresses
Primary practice location
9089 Baseline Rd
Suite 200
Rancho Cucamonga, CA 91730-1295
Mailing address
7828 Haven Ave
Suite 212
Rancho Cucamonga, CA 91730-3049
Phone (909) 987-1647
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140708000240 | CA | Practitioner - Clinical Social Worker | 6002031093 | Practice locations: Indio, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCS 22188 | CA | MD | Clinical Social Worker |
| 22188 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1380153600000",
"number": "1467509968",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7828 HAVEN AVE",
"address_2": "SUITE 212",
"city": "RANCHO CUCAMONGA",
"state": "CA",
"postal_code": "917303049",
"telephone_number": "909-987-1647",
"fax_number": "909-798-7909"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9089 BASELINE RD",
"address_2": "SUITE 200",
"city": "RANCHO CUCAMONGA",
"state": "CA",
"postal_code": "917301295",
"telephone_number": "909-210-5895",
"fax_number": "909-989-3932"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARVILLE WASHINGTON",
"first_name": "GWENDOLYN",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-05",
"last_updated": "2013-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCS 22188",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rancho Cucamonga, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.