Active NPI
Richard T. Sullivan, LCSW
- Clinical Social Worker
- San Diego, CA
National Provider Identifier
1609980069
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCS 22982
- Practice address
- 5675 Ruffin Rd
Suite 325
San Diego, CA 92123-1424 - Phone
- (858) 467-9170
- Fax
- (858) 467-9183
- NPI assigned
- Aug 19, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCS 22982 | CA | Primary |
| Clinical Social Worker | 1041C0700X | 5139758-3501 | UT |
Addresses
Primary practice location
5675 Ruffin Rd
Suite 325
San Diego, CA 92123-1424
Mailing address
5675 Ruffin Rd
Suite 325
San Diego, CA 92123-1424
Phone (858) 467-9170
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Mar 3, 2017 through Mar 3, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCS 22982 | CA | MD | Clinical Social Worker |
| 5139758-3501 | UT | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| LDS Family Services | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- San Diego, CA
- NPI 1710069281
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1609980069",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5675 RUFFIN RD",
"address_2": "SUITE 325",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921231424",
"telephone_number": "858-467-9170",
"fax_number": "858-467-9183"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5675 RUFFIN RD",
"address_2": "SUITE 325",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921231424",
"telephone_number": "858-467-9170",
"fax_number": "858-467-9183"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "RICHARD",
"middle_name": "T.",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCS 22982",
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "UT",
"license": "5139758-3501",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.