Individual provider Active NPI

William Randle, LISW

  • Clinical Social Worker
  • Burbank, CA
National Provider Identifier
1821181637
Registry record updated Sep 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
I10245 Issued in OH
Practice address
500 E Olive Ave Ste 240
Burbank, CA 91501-2171
Phone
(614) 293-9550
Fax
(614) 293-9549
NPI assigned
Oct 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2020

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 I10245 OH Primary

Addresses

Primary practice location

500 E Olive Ave Ste 240
Burbank, CA 91501-2171

Mailing address

445 E Dublin Granville Rd
BLDG N
Worthington, OH 43085-3192
Phone (614) 293-9550

Other practice location 1

5655 N High St
Worthington, OH 43085-3948
Phone (614) 505-6977

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

LicenseStateTypeSpecialty
I10245OHMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Jack Stoneburner & Associates LLC CurrentSince Feb 1, 2020 Accepting new patients
Center for Eating Disorders & Psychotherapy PastSince Oct 23, 2022 Accepting new patients
Emily Program PC PastSince Aug 10, 2013 Accepting new patients

Locations

5655 N High St
Ste 208
Worthington, OH 43085
Phone (614) 505-6977

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": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599609600000",
    "number": "1821181637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "445 E DUBLIN GRANVILLE RD",
            "address_2": "BLDG N",
            "city": "WORTHINGTON",
            "state": "OH",
            "postal_code": "430853192",
            "telephone_number": "614-293-9550",
            "fax_number": "614-293-9549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 E OLIVE AVE STE 240",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915012171",
            "telephone_number": "614-293-9550",
            "fax_number": "614-293-9549"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5655 N High St",
            "address_purpose": "LOCATION",
            "city": "Worthington",
            "state": "OH",
            "postal_code": "430853948",
            "country_code": "US",
            "telephone_number": "614-505-6977",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RANDLE",
        "first_name": "WILLIAM",
        "credential": "LISW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2020-09-09",
        "certification_date": "2020-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I10245",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burbank, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.