Katelyn Vandever, ASW #120967

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

120967 Issued in CA

Practice address

822 D St
San Rafael, CA 94901-2814

Phone

(917) 526-1913

NPI assigned

Mar 27, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1711497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711497600000",
    "number": "1841041027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "72 OAK KNOLL AVE",
            "city": "SAN ANSELMO",
            "state": "CA",
            "postal_code": "949601868",
            "telephone_number": "917-526-1913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "822 D ST",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949012814",
            "telephone_number": "917-526-1913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDEVER",
        "first_name": "KATELYN",
        "credential": "ASW #120967",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-27",
        "last_updated": "2024-03-27",
        "certification_date": "2024-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "120967",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marta Van Leuven, M.F.T.
• Lesley Ann Van Voorhees, M.S.W.
• Christine M Vandenbroucke-Bouckaert, PH.D.IN CLINICAL PSY
• Debra Ann Vandergriend
• Jeffrey Neil Vanderheym, D.C.
• Leslie Vandyke
• Natalie Marie Vano
• Heather Vantress, LIC.AC.
• Ruud Vanwijnen, PH.D.
• David Vara

• Clinical Social Worker in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 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.

Verify at the official NPI Registry.