Individual provider Active NPI

Vincent Depaul Brock, LCSW

  • Clinical Social Worker
  • Santa Fe Springs, CA
National Provider Identifier
1629152376
Registry record updated Dec 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCS24329 Issued in CA
Practice address
10355 Slusher Dr
Santa Fe Springs, CA 90670-7353
Phone
(562) 903-7392
Fax
(562) 944-2316
NPI assigned
Oct 25, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 2, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 12370 CA
Clinical Social Worker 1041C0700X LCS24329 CA Primary

Addresses

Primary practice location

10355 Slusher Dr
Santa Fe Springs, CA 90670-7353

Mailing address

10355 Slusher Dr
Santa Fe Springs, CA 90670-7353
Phone (562) 903-7392

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131112001929 CA Practitioner - Clinical Social Worker 8426284803 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCS24329CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Sep 14, 2015 Accepting new patients
Los Angeles County Department of Mental Health Current Accepting new patients
Los Angeles County Department of Mental Health CurrentSince Jul 23, 2013 Accepting new patients
Southern California Permanente Medical Group CurrentSince Sep 14, 2015 Accepting new patients
Los Angeles County Department of Mental Health CurrentSince Jul 23, 2013 Accepting new patients

Locations

3733 San Dimas St
Ste 101
Bakersfield, CA 93301
Phone (800) 353-5400

17707 Studebaker Rd
#150
Cerritos, CA 90703
Phone (310) 402-0688

9961 Sierra Ave
Fontana, CA 92335
Phone (909) 427-3910

510 S Vermont Ave
Fl 19
Los Angeles, CA 90020
Phone (213) 480-3416

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

Organizations & group practices 6

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": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638403200000",
    "number": "1629152376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10355 SLUSHER DR",
            "city": "SANTA FE SPRINGS",
            "state": "CA",
            "postal_code": "906707353",
            "telephone_number": "562-903-7392",
            "fax_number": "562-944-2316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10355 SLUSHER DR",
            "city": "SANTA FE SPRINGS",
            "state": "CA",
            "postal_code": "906707353",
            "telephone_number": "562-903-7392",
            "fax_number": "562-944-2316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCK",
        "first_name": "VINCENT",
        "middle_name": "DEPAUL",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-25",
        "last_updated": "2021-12-02",
        "certification_date": "2021-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "12370",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS24329",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "c-cda",
            "address_1": "9961 Sierra Ave",
            "city": "Fontana",
            "state": "CA",
            "country_code": "US",
            "postal_code": "923356720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Santa Fe Springs, CA

Sources for this page

Verify at the official NPI Registry.