Individual provider Active NPI

Marilyn Virginia Smith, LCSW

  • Clinical Social Worker
  • Santa Ana, CA
National Provider Identifier
1689766164
Registry record updated Apr 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
22298 Issued in CA
Practice address
2030 E 4TH St
Suite G-152
Santa Ana, CA 92705-3940
Phone
(949) 466-3213
NPI assigned
Sep 29, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 18, 2016

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 22298 CA Primary
Mental Health Counselor 101YM0800X LCSW22298 CA

Addresses

Primary practice location

2030 E 4TH St
Suite G-152
Santa Ana, CA 92705-3940

Mailing address

2030 E 4TH St
Suite G-152
Santa Ana, CA 92705-3940
Phone (949) 466-3213

Other identifiers 1

IdentifierTypeStateIssuer
22298OtherCALCSW LICENSE NUMBER

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
I20160504001989 CA Practitioner - Clinical Social Worker 0547569006 Practice locations: Irvine, CA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

31 Westport
Irvine, CA 92620-2656
Phone (949) 466-3213

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCSW22298CAMDMental Health Counselor

NPI Registry JSON

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

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460937600000",
    "number": "1689766164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2030 E 4TH ST",
            "address_2": "SUITE G-152",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927053940",
            "telephone_number": "949-466-3213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2030 E 4TH ST",
            "address_2": "SUITE G-152",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927053940",
            "telephone_number": "949-466-3213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "MARILYN",
        "middle_name": "VIRGINIA",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-29",
        "last_updated": "2016-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "22298",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "LCSW22298",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LCSW LICENSE NUMBER",
            "identifier": "22298",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Ana, CA

Sources for this page

Verify at the official NPI Registry.