Individual provider Active NPI

Lydia M Herbert, LCSW

  • Clinical Social Worker
  • Canon City, CO
National Provider Identifier
1831255058
Registry record updated Dec 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
991837 Issued in CO
Practice address
3225 Independence Rd.
Canon City, CO 81212
Phone
(719) 275-2351
NPI assigned
Dec 29, 2006
Last updated
Dec 18, 2019By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 18, 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 991837 CO Primary

Addresses

Primary practice location

3225 Independence Rd.
Canon City, CO 81212

Mailing address

712 Yale PL Apt a
Canon City, CO 81212-4647
Phone (719) 431-7057

Other identifiers 1

IdentifierTypeStateIssuer
077718OtherWAVALUE OPTIONS PROVIDER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20050610000811 CO Practitioner - Clinical Social Worker 9335183300 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1995
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

3225 Independence Rd
Canon City, CO 81212-9380
Phone (719) 275-2351

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
991837COMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
West Central Mental Health Center, Inc. Current Accepting new patients
West Central Mental Health Center Inc. CurrentSince Aug 30, 2016 Accepting new patients
West Central Mental Health Center, Inc. CurrentSince Aug 30, 2016 Accepting new patients

Locations

3225 Independence Rd
Canon City, CO 81212
Phone (719) 275-2351

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576627200000",
    "number": "1831255058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "712 YALE PL APT A",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812124647",
            "telephone_number": "719-431-7057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3225 INDEPENDENCE RD.",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "81212",
            "telephone_number": "719-275-2351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERBERT",
        "first_name": "LYDIA",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-29",
        "last_updated": "2019-12-18",
        "certification_date": "2019-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "991837",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS PROVIDER",
            "identifier": "077718",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canon City, CO

Sources for this page

Verify at the official NPI Registry.