Individual provider Active NPI

Courtney Blake Sage, LCSW

  • Social Worker
  • Fremont, CA
National Provider Identifier
1508299223
Registry record updated Jan 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
29835 Issued in CA
Practice address
39155 Liberty St
G710
Fremont, CA 94538-1513
Phone
(510) 795-2423
NPI assigned
Aug 16, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2014

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X CA
Social Worker 104100000X 26149 ASW CA
Social Worker 104100000X 29835 CA Primary

Addresses

Primary practice location

39155 Liberty St
G710
Fremont, CA 94538-1513

Mailing address

39155 Liberty St
G710
Fremont, CA 94538-1513
Phone (510) 795-2423

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

LicenseStateTypeSpecialty
26149 ASWCAMDSocial Worker
29835CAMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1376611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1388966400000",
    "number": "1508299223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39155 LIBERTY ST",
            "address_2": "G710",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381513",
            "telephone_number": "510-795-2423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39155 LIBERTY ST",
            "address_2": "G710",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381513",
            "telephone_number": "510-795-2423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAGE",
        "first_name": "COURTNEY",
        "middle_name": "BLAKE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-16",
        "last_updated": "2014-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CA",
            "license": "26149 ASW",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CA",
            "license": "29835",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fremont, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2014; 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.