Active NPI
Gena H Ninivaggio, LCSW
- Clinical Social Worker
- Vacaville, CA
National Provider Identifier
1700011202
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCS21793
- Practice address
- 1600 California Dr
Vacaville, CA 95687 - Phone
- (707) 448-6841
- Fax
- (707) 453-7015
- NPI assigned
- May 27, 2009
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCS21793 | CA | Primary |
Addresses
Primary practice location
1600 California Dr
Vacaville, CA 95687
Mailing address
PO Box 5401
Walnut Creek, CA 94596-1401
Phone (707) 317-3208
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCS21793 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1243382400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1312848000000",
"number": "1700011202",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5401",
"city": "WALNUT CREEK",
"state": "CA",
"postal_code": "945961401",
"telephone_number": "707-317-3208"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 CALIFORNIA DR",
"city": "VACAVILLE",
"state": "CA",
"postal_code": "95687",
"telephone_number": "707-448-6841",
"fax_number": "707-453-7015"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NINIVAGGIO",
"first_name": "GENA",
"middle_name": "H",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-05-27",
"last_updated": "2011-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCS21793",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vacaville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 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.