Active NPI
John J Roorda, LCSW
- Clinical Social Worker
- San Luis Obispo, CA
National Provider Identifier
1477565190
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCS17845
- Practice address
- 11549 Los Osos Valley Rd
Suite 202
San Luis Obispo, CA 93405-6471 - Phone
- (805) 782-9147
- NPI assigned
- Aug 12, 2006
- Sex
- Male
- 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 | LCS17845 | CA | Primary |
Addresses
Primary practice location
11549 Los Osos Valley Rd
Suite 202
San Luis Obispo, CA 93405-6471
Mailing address
11549 Los Osos Valley Rd
Suite 202
San Luis Obispo, CA 93405-6471
Phone (805) 782-9147
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective May 28, 2025 through May 28, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCS17845 | CA | MD | Clinical Social Worker |
| 17845 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155340800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1477565190",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11549 LOS OSOS VALLEY RD",
"address_2": "SUITE 202",
"city": "SAN LUIS OBISPO",
"state": "CA",
"postal_code": "934056471",
"telephone_number": "805-782-9147"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11549 LOS OSOS VALLEY RD",
"address_2": "SUITE 202",
"city": "SAN LUIS OBISPO",
"state": "CA",
"postal_code": "934056471",
"telephone_number": "805-782-9147"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROORDA",
"first_name": "JOHN",
"middle_name": "J",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCS17845",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Luis Obispo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.