Active NPI
Douglas Ulysses George, ASW
- Clinical Social Worker
- La Verne, CA
National Provider Identifier
1487048070
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 93830
- Practice address
- 1025 Sentinel Dr
Suite 200
La Verne, CA 91750-3280 - Phone
- (909) 833-2986
- Fax
- (909) 833-2998
- NPI assigned
- Mar 23, 2015
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Social Worker | 104100000X | ASW65434 | CA | |
| Clinical Social Worker | 1041C0700X | 93830 | CA | Primary |
Addresses
Primary practice location
1025 Sentinel Dr
Suite 200
La Verne, CA 91750-3280
Mailing address
1540 Via Buena
La Verne, CA 91750-2052
Phone (909) 706-7288
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 |
|---|---|---|---|
| ASW65434 | CA | MD | Social Worker |
| 93830 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Haynes Family of Programs | Past | Accepting new patients | |
| Haynes Family of Programs | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
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- La Verne, CA
- NPI 1164548236
-
- Mental Illness Community Based Residential Treatment Facility
- La Verne, CA
- NPI 1851642193
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1427068800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1579824000000",
"number": "1487048070",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1540 VIA BUENA",
"city": "LA VERNE",
"state": "CA",
"postal_code": "917502052",
"telephone_number": "909-706-7288"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1025 SENTINEL DR",
"address_2": "SUITE 200",
"city": "LA VERNE",
"state": "CA",
"postal_code": "917503280",
"telephone_number": "909-833-2986",
"fax_number": "909-833-2998"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GEORGE",
"first_name": "DOUGLAS",
"middle_name": "ULYSSES",
"name_prefix": "Mr.",
"credential": "ASW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-03-23",
"last_updated": "2020-01-24",
"certification_date": "2020-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "CA",
"license": "ASW65434",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "93830",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Verne, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.