Active NPI
Mary M Gough, LCSW
- Clinical Social Worker
- Placerville, CA
National Provider Identifier
1528205994
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 93472
- Practice address
- 929 Spring St
Placerville, CA 95667-4543 - Phone
- (530) 621-6303
- NPI assigned
- Jan 7, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | |||
| Mental Health Counselor | 101YM0800X | |||
| Clinical Social Worker | 1041C0700X | 93472 | CA | Primary |
Addresses
Primary practice location
929 Spring St
Placerville, CA 95667-4543
Mailing address
929 Spring St
Placerville, CA 95667-4543
Phone (530) 621-6303
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 |
|---|---|---|---|
| 93472 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1231286400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1688688000000",
"number": "1528205994",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "929 SPRING ST",
"city": "PLACERVILLE",
"state": "CA",
"postal_code": "956674543",
"telephone_number": "530-621-6303"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "929 SPRING ST",
"city": "PLACERVILLE",
"state": "CA",
"postal_code": "956674543",
"telephone_number": "530-621-6303"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOUGH",
"first_name": "MARY",
"middle_name": "M",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-01-07",
"last_updated": "2023-07-07",
"certification_date": "2023-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "93472",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Placerville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.