Active NPI
Ellen Susan Lodge, LCSW
- Clinical Social Worker
- Atascadero, CA
National Provider Identifier
1710040993
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 19187
- Practice address
- 6470 Lewis Ave
Atascadero, CA 93422-4229 - Phone
- (805) 264-4050
- NPI assigned
- Dec 18, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 | 19187 | CA | Primary |
Addresses
Primary practice location
6470 Lewis Ave
Atascadero, CA 93422-4229
Mailing address
PO Box 6395
Los Osos, CA 93412-6395
Phone (805) 264-4050
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19187 | CA | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1710040993",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 6395",
"city": "LOS OSOS",
"state": "CA",
"postal_code": "934126395",
"telephone_number": "805-264-4050",
"fax_number": "805-534-1967"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6470 LEWIS AVE",
"city": "ATASCADERO",
"state": "CA",
"postal_code": "934224229",
"telephone_number": "805-264-4050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LODGE",
"first_name": "ELLEN",
"middle_name": "SUSAN",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "19187",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atascadero, CA
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.