Active NPI
Audrey McDougal
- Clinical Social Worker
- San Leandro, CA
National Provider Identifier
1811236417
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW106518
- Practice address
- 400 Estudillo Ave Ste 100
San Leandro, CA 94577-4962 - Phone
- (510) 352-9200
- NPI assigned
- Feb 4, 2013
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | ASW87597 | CA | |
| Clinical Social Worker | 1041C0700X | LCSW106518 | CA | Primary |
Addresses
Primary practice location
400 Estudillo Ave Ste 100
San Leandro, CA 94577-4962
Mailing address
400 Estudillo Ave Ste 100
San Leandro, CA 94577-4962
Phone (510) 352-9200
Other practice location 1
77 Mill St
Westfield, MA 01085-4598
Phone (413) 572-4111
Other practice location 2
545 Estudillo Ave
San Leandro, CA 94577-4611
Phone (510) 352-9200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1300881 | Medicaid | MA |
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 |
|---|---|---|---|
| ASW87597 | CA | MD | Mental Health Counselor |
| LCSW106518 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1359936000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717977600000",
"number": "1811236417",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 ESTUDILLO AVE STE 100",
"city": "SAN LEANDRO",
"state": "CA",
"postal_code": "945774962",
"telephone_number": "510-352-9200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 ESTUDILLO AVE STE 100",
"city": "SAN LEANDRO",
"state": "CA",
"postal_code": "945774962",
"telephone_number": "510-352-9200"
}
],
"practiceLocations": [
{
"address_1": "77 Mill St",
"address_purpose": "LOCATION",
"city": "Westfield",
"state": "MA",
"postal_code": "010854598",
"country_code": "US",
"telephone_number": "413-572-4111",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "545 Estudillo Ave",
"address_purpose": "LOCATION",
"city": "San Leandro",
"state": "CA",
"postal_code": "945774611",
"country_code": "US",
"telephone_number": "510-352-9200",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MCDOUGAL",
"first_name": "AUDREY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-02-04",
"last_updated": "2024-06-10",
"certification_date": "2024-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "ASW87597",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCSW106518",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1300881",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Leandro, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.