Active NPI
Charlean Clemons, LCSW
- Clinical Social Worker
- Salem, OR
National Provider Identifier
1740310457
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- L3994
- Practice address
- 965 Liberty Street SE
Poyama Counseling
Salem, OR 97302 - Phone
- (503) 588-2004
- Fax
- (503) 588-2415
- NPI assigned
- Mar 6, 2007
- 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 | L3994 | OR | Primary |
Addresses
Primary practice location
965 Liberty Street SE
Poyama Counseling
Salem, OR 97302
Mailing address
965 Liberty Street SE
Poyama Counseling
Salem, OR 97302
Phone (503) 588-2004
Other names 1
- Charlean Clemons Gerling
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 1991
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
965 Liberty St SE
Salem, OR 97302-4138
Phone (503) 588-2004
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L3994 | OR | MD | Clinical Social Worker |
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.
-
dba Poyama Counseling Services
- Counselor
- Salem, OR
- NPI 1760685176
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1740310457",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "965 LIBERTY STREET SE",
"address_2": "POYAMA COUNSELING",
"city": "SALEM",
"state": "OR",
"postal_code": "97302",
"telephone_number": "503-588-2004",
"fax_number": "503-588-2415"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "965 LIBERTY STREET SE",
"address_2": "POYAMA COUNSELING",
"city": "SALEM",
"state": "OR",
"postal_code": "97302",
"telephone_number": "503-588-2004",
"fax_number": "503-588-2415"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLEMONS",
"first_name": "CHARLEAN",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OR",
"license": "L3994",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "CHARLEAN",
"last_name": "GERLING",
"middle_name": "CLEMONS",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Salem, OR
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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.