Active NPI
Laura Mae Van Waardenburg, LCSW
- Clinical Social Worker
- Sonoma, CA
National Provider Identifier
1528290400
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 29431
- Practice address
- 19343 Highway 12
Sonoma, CA 95476-5445 - Phone
- (415) 596-2023
- NPI assigned
- Aug 11, 2009
- 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 | 29431 | CA | Primary |
Addresses
Primary practice location
19343 Highway 12
Sonoma, CA 95476-5445
Mailing address
400 E Thomson Ave
Sonoma, CA 95476-8442
Phone (415) 596-2023
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 29431 | Other | CA | CALIFORNIA BOARD OF BEHAVIORAL SCIENCES, LICENSED CLINICAL SOCIAL WORKER |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 29431 | CA | MD | Radiology Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1249948800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1525305600000",
"number": "1528290400",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 E THOMSON AVE",
"city": "SONOMA",
"state": "CA",
"postal_code": "954768442",
"telephone_number": "415-596-2023"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19343 HIGHWAY 12",
"city": "SONOMA",
"state": "CA",
"postal_code": "954765445",
"telephone_number": "415-596-2023"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN WAARDENBURG",
"first_name": "LAURA",
"middle_name": "MAE",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-08-11",
"last_updated": "2018-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "29431",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CALIFORNIA BOARD OF BEHAVIORAL SCIENCES, LICENSED CLINICAL SOCIAL WORKER",
"identifier": "29431",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sonoma, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.