Individual provider Active NPI

Gina Marie Vaughn Williams, LCSW

  • Clinical Social Worker
  • Palm Springs, CA
National Provider Identifier
1710020490
Registry record updated Sep 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW28554 Issued in CA
Practice address
1091 N Palm Canyon Dr
Palm Springs, CA 92262-4419
Phone
(805) 981-7889
NPI assigned
Feb 14, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 21, 2025

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 LCSW28554 CA Primary

Addresses

Primary practice location

1091 N Palm Canyon Dr
Palm Springs, CA 92262-4419

Mailing address

PO Box 1235
Palm Springs, CA 92263-1235
Phone (530) 321-0787

Other identifiers 1

IdentifierTypeStateIssuer
33G3700MedicaidCA

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
I20170929003445 CA Practitioner - Clinical Social Worker 5294000287 Reassigns benefits to 1 organization
Practice locations: Palm Springs, CA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1091 N Palm Canyon Dr
Palm Springs, CA 92262-4419
Phone (760) 537-5125

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCSW28554CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Sud Specialty Group - Ca Clinical CurrentSince May 1, 2025 Accepting new patients

Locations

5201 Great America Pkwy
Ste 320
Santa Clara, CA 95054
Phone (323) 968-6182

4633 Old Ironsides Dr
Ste 304
Santa Clara, CA 95054
Phone (501) 271-9428

520 Broadway
Ste 200
Santa Monica, CA 90401
Phone (949) 280-5295

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

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": "1171411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758412800000",
    "number": "1710020490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1235",
            "city": "PALM SPRINGS",
            "state": "CA",
            "postal_code": "922631235",
            "telephone_number": "530-321-0787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1091 N PALM CANYON DR",
            "city": "PALM SPRINGS",
            "state": "CA",
            "postal_code": "922624419",
            "telephone_number": "805-981-7889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAUGHN WILLIAMS",
        "first_name": "GINA",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-14",
        "last_updated": "2025-09-21",
        "certification_date": "2025-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW28554",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33G3700",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Springs, CA

Sources for this page

Verify at the official NPI Registry.