Individual provider Active NPI

Marvin Willard Jones, PH.D.,LCSW

  • Clinical Social Worker
  • Oakland, CA
National Provider Identifier
1700990892
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCS3957 Issued in CA
Practice address
465 34TH St
Oakland, CA 94609-2815
Phone
(510) 658-3364
Fax
(510) 658-3299
NPI assigned
Aug 18, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LCS3957 CA Primary

Addresses

Primary practice location

465 34TH St
Oakland, CA 94609-2815

Mailing address

465 34TH St
Oakland, CA 94609-2815
Phone (510) 658-3364

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
I20050513000815 CA Practitioner - Clinical Social Worker 2365483831 Practice locations: Oakland, CA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1970
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

465 34TH St
Oakland, CA 94609-2815
Phone (510) 658-3364

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
LCS3957CAMDClinical Social Worker
3957CAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Peter Oppermann PHD Psychology Prof. Corp. Past Accepting new patients

Organizations & group practices 1

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": "1155859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1700990892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "465 34TH ST",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946092815",
            "telephone_number": "510-658-3364",
            "fax_number": "510-658-3299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "465 34TH ST",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946092815",
            "telephone_number": "510-658-3364",
            "fax_number": "510-658-3299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JONES",
        "first_name": "MARVIN",
        "middle_name": "WILLARD",
        "name_prefix": "Dr.",
        "credential": "PH.D.,LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS3957",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakland, CA

Sources for this page

Verify at the official NPI Registry.