Active NPI
Mary J Stavn
- Clinical Social Worker
- East Palo Alto, CA
National Provider Identifier
1639296601
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCS 26145
- Practice address
- 2415 University Ave
East Palo Alto, CA 94303-1164 - Phone
- (650) 363-4030
- Fax
- (650) 328-6834
- NPI assigned
- Mar 23, 2007
- Last updated
- Dec 2, 2011
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Social Worker | 104100000X | ASW17637 | CA | |
| Clinical Social Worker | 1041C0700X | LCS 26145 | CA | Primary |
Addresses
Primary practice location
2415 University Ave
East Palo Alto, CA 94303-1164
Mailing address
2415 University Ave
East Palo Alto, CA 94303-1164
Phone (650) 363-4030
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 |
|---|---|---|---|
| ASW17637 | CA | MD | Social Worker |
| LCS 26145 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174608000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1322784000000",
"number": "1639296601",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2415 UNIVERSITY AVE",
"city": "EAST PALO ALTO",
"state": "CA",
"postal_code": "943031164",
"telephone_number": "650-363-4030",
"fax_number": "650-328-6834"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2415 UNIVERSITY AVE",
"city": "EAST PALO ALTO",
"state": "CA",
"postal_code": "943031164",
"telephone_number": "650-363-4030",
"fax_number": "650-328-6834"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STAVN",
"first_name": "MARY",
"middle_name": "J",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-23",
"last_updated": "2011-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "CA",
"license": "ASW17637",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCS 26145",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Palo Alto, CA
- Lorena Sotelo Malaga, R.N.
- South County Community Health Center Inc (Ravenswood Family Health Network)
- South County Community Health Center Inc. (Ravenswood Family Health Center)
- South County Community Health Center, Inc. (Ravenswood Family Dentistry)
- South County Community Health Center, Inc. (Ravenswood Family Health Center Pharmacy)
- Chiara Elaine Stetson, NP
- Cheryl J Sundheim, IBCLC
- Superior Transport Group, LLC (Superior Medical Transport)
- Joan Elizabeth Sykes-Miessi
- Colleen Marie Szabo
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.