Wamaitha Whidby, LCSW
Individual provider Active NPI Clinical Social Worker · Ceres, CA
NPI 1609084763 · NPPES record last updated Jun 18, 2023
Key facts
- NPI
- 1609084763
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- LCSW65927 (CA)
- Practice address
- 1904 Richland Ave Ste C2
Ceres, CA 95307-4562 - Phone
- (209) 525-5079
- NPI assigned
- May 20, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160603001803 | CA | Practitioner - Clinical Social Worker | 5991095937 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW65927 | CA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Krishnamoorthi MD Inc a Professional Medical Corporation | Current | Accepting new patients | |
| County of Stanislaus | Current |
Accepting new patients | |
| County of Stanislaus | Current |
Accepting new patients |
Locations
1904 Richland Ave
Ste C2
Ceres, CA 95307
Phone (209) 525-5079
850 California St
Escalon, CA 95320
Phone (209) 838-2278
800 Scenic Dr
Modesto, CA 95350
Phone (209) 525-5369
500 N 9th St
Ste B
Modesto, CA 95350
Phone (209) 341-1824
303 Downey Ave
Modesto, CA 95354
Phone (209) 525-4920
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCSW65927 | CA | Yes |
Addresses
Primary practice location
1904 Richland Ave Ste C2
Ceres, CA 95307-4562
Mailing address
1904 Richland Ave Ste C2
Ceres, CA 95307-4562
Phone (209) 525-5079
Other providers in Ceres, CA
- Elizabeth Catalina Weil
- Alyssa Wells
- Western Dental Services, Inc.
- Robert Daniel Weston
- Wheels on Wheels Transportation
- Kristen Denise White-Madsen
- Travis Shawn Whitehead
- Deborah Whitten
- William J Kalanta D.P.M.
- Kimberly Williams-White
All providers in Ceres, CA · Clinical Social Worker in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 18, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.