Active NPI
Marvin Paul Vernon, LCSW
- Clinical Social Worker
- Blythe, CA
National Provider Identifier
1821262767
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCS18547
- Practice address
- 246 N Hobson Way
Blythe, CA 92225 - Phone
- (760) 921-5004
- NPI assigned
- Apr 22, 2008
- Sex
- Male
- 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 | LCS18547 | CA | Primary |
Addresses
Primary practice location
246 N Hobson Way
Blythe, CA 92225
Mailing address
81711 Hwy 111
Ste 101
Indio, CA 92201
Phone (760) 347-2398
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 |
|---|---|---|---|
| LCS18547 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1208822400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1208822400000",
"number": "1821262767",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "81711 HWY 111",
"address_2": "STE 101",
"city": "INDIO",
"state": "CA",
"postal_code": "92201",
"telephone_number": "760-347-2398",
"fax_number": "760-347-6468"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "246 N HOBSON WAY",
"city": "BLYTHE",
"state": "CA",
"postal_code": "92225",
"telephone_number": "760-921-5004"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VERNON",
"first_name": "MARVIN",
"middle_name": "PAUL",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-04-22",
"last_updated": "2008-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCS18547",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Blythe, CA
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- Eddie Vega
- Patrick Vessey
- Veterans Alcohol Rehabilitation Program, Inc.- Varp, Inc.
- Veterans Alcohol Rehabilitation Program, Inc.-Varp, Inc.
- Michael J. Villa
- Srinivas Bhawani Vuthoori, M.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.