Active NPI
Marcia Kullback
- Clinical Social Worker
- Camarillo, CA
National Provider Identifier
1740416619
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 10162
- Practice address
- 5284 Adolfo Rd
Camarillo, CA 93012 - Phone
- (805) 289-0120
- NPI assigned
- Jun 5, 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 | 10162 | CA | Primary |
Addresses
Primary practice location
5284 Adolfo Rd
Camarillo, CA 93012
Mailing address
5284 Adolfo Rd
Camarillo, CA 93012-6787
Phone (805) 289-0120
Other practice location 1
975 Flynn Rd
Camarillo, CA 93012-8704
Phone (805) 388-7740
Other practice location 2
975 Flynn Rd
Camarillo, CA 93012-8704
Phone (805) 388-7740
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 |
|---|---|---|---|
| 10162 | CA | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Teladoc Health Medical Group, P.a. | Clinical | Current | Accepting new patients |
Interoperability endpoints
- marciakullback@tdh.allscriptsdirect.net
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": "1244160000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548115200000",
"number": "1740416619",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5284 ADOLFO RD",
"city": "CAMARILLO",
"state": "CA",
"postal_code": "930126787",
"telephone_number": "805-289-0120"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5284 ADOLFO RD",
"city": "CAMARILLO",
"state": "CA",
"postal_code": "93012",
"telephone_number": "805-289-0120"
}
],
"practiceLocations": [
{
"address_1": "975 Flynn Rd",
"address_purpose": "LOCATION",
"city": "Camarillo",
"state": "CA",
"postal_code": "930128704",
"country_code": "US",
"telephone_number": "805-388-7740",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "975 Flynn Rd",
"address_purpose": "LOCATION",
"city": "Camarillo",
"state": "CA",
"postal_code": "930128704",
"country_code": "US",
"telephone_number": "805-388-7740",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KULLBACK",
"first_name": "MARCIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-06-05",
"last_updated": "2019-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "10162",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Camarillo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.