Cynthia Lynn Wall, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCS11193 Issued in CA

Practice address

30077 Simpson LN
Fort Bragg, CA 95437-7759

Phone

(707) 964-5229

Fax

(707) 964-5766

NPI assigned

Nov 3, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Clinical Social Worker

Education

Other, 1977

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1649359001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30077 SIMPSON LN",
            "address_2": "PO BOX 2082",
            "city": "FORT BRAGG",
            "state": "CA",
            "postal_code": "954377759",
            "telephone_number": "707-964-5229",
            "fax_number": "707-964-5766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30077 SIMPSON LN",
            "city": "FORT BRAGG",
            "state": "CA",
            "postal_code": "954377759",
            "telephone_number": "707-964-5229",
            "fax_number": "707-964-5766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "CYNTHIA",
        "middle_name": "LYNN",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS11193",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer C Van Wormer
• Kei Julia Velazquez, CNM
• Kathryn Elaine Voskuyl
• Debra Wagner, M.A., M.F.T.
• Sarah Wagner
• John T Wallace II, MD
• Lindsay Aden Wansbury, MFT
• Magdalena Weinstein
• Caroline Wells, PA-C
• Elizabeth Wells, DC

• Clinical Social Worker in Fort Bragg, CA
• Providers in Fort Bragg, CA by specialty
• Clinical Social Worker in California

• 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.