NPIMap

Individual provider Active NPI

Carol-Anne Pugliese

  • Clinical Social Worker
  • San Rafael, CA
National Provider Identifier
1578069001
Registry record updated May 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
114251 Issued in CA
Practice address
1 Saint Vincents Dr
San Rafael, CA 94903-1504
Phone
(415) 507-2000
NPI assigned
Apr 3, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2023

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X
Mental Health Counselor 101YM0800X 96384 CA
Clinical Social Worker 1041C0700X 96384 CA
Student in an Organized Health Care Education/Training Program 390200000X
Clinical Social Worker 1041C0700X 114251 CA Primary

Addresses

Primary practice location

1 Saint Vincents Dr
San Rafael, CA 94903-1504

Mailing address

73 Roundtree Blvd
San Rafael, CA 94903-1633
Phone (516) 318-1663

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

LicenseStateTypeSpecialty
114251CAMDClinical Social Worker
96384CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Community Institute for Psychotherapy Past Accepting new patients
Community Institute for Psychotherapy 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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1522713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684281600000",
    "number": "1578069001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "73 ROUNDTREE BLVD",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949031633",
            "telephone_number": "516-318-1663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 SAINT VINCENTS DR",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949031504",
            "telephone_number": "415-507-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUGLIESE",
        "first_name": "CAROL-ANNE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-03",
        "last_updated": "2023-05-17",
        "certification_date": "2023-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "96384",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "96384",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "114251",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Rafael, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 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.

Verify at the official NPI Registry.