Individual provider Active NPI

Katherine M. Heisler, LCSW

  • Clinical Social Worker
  • Ontario, CA
National Provider Identifier
1811420102
Registry record updated Nov 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW75901 Issued in CA
Practice address
3400 Inland Empire Blvd Ste 101
Ontario, CA 91764-5577
Phone
(909) 378-6070
Fax
(909) 259-2457
NPI assigned
Apr 4, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 21, 2019

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 LCSW75901 CA Primary

Addresses

Primary practice location

3400 Inland Empire Blvd Ste 101
Ontario, CA 91764-5577

Mailing address

3400 Inland Empire Blvd Ste 101
Ontario, CA 91764-5577
Phone (909) 378-6070

Other practice location 1

2813 S Main St
Corona, CA 92882-5942
Phone (951) 272-5445

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
I20191125003037 CA Practitioner - Clinical Social Worker 5890128227 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCSW75901CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
County of Riverside CurrentSince Oct 1, 2019 Accepting new patients
County of Riverside CurrentSince Oct 1, 2019 Accepting new patients
County of Riverside Current Accepting new patients

Locations

308 E San Jacinto Ave
Perris, CA 92570
Phone (951) 940-6700

Organizations & group practices 3

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": "1491264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574294400000",
    "number": "1811420102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 INLAND EMPIRE BLVD STE 101",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917645577",
            "telephone_number": "909-378-6070",
            "fax_number": "909-259-2457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 INLAND EMPIRE BLVD STE 101",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917645577",
            "telephone_number": "909-378-6070",
            "fax_number": "909-259-2457"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2813 S Main St",
            "address_purpose": "LOCATION",
            "city": "Corona",
            "state": "CA",
            "postal_code": "928825942",
            "country_code": "US",
            "telephone_number": "951-272-5445",
            "fax_number": "951-272-5489",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HEISLER",
        "first_name": "KATHERINE",
        "middle_name": "M.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-04-04",
        "last_updated": "2019-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW75901",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ontario, CA

Sources for this page

Verify at the official NPI Registry.