Janet L Black, LCSW
Individual provider Active NPI Clinical Social Worker · Sonora, CA
NPI 1861472060 · NPPES record last updated Mar 12, 2024
Key facts
- NPI
- 1861472060
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- LCS19200 (CA)
- Practice address
- 13975 Mono Way Ste H
Sonora, CA 95370-2824 - Phone
- (209) 533-9606
- NPI assigned
- Jan 23, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA, TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060131000266 | CA | Practitioner - Clinical Social Worker | 1850305764 | |
| I20241126000164 | TX | Practitioner - Clinical Social Worker | 1850305764 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCS19200 | CA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| M a C T Health Board Incorporated | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCS19200 | CA | Yes |
Addresses
Primary practice location
13975 Mono Way Ste H
Sonora, CA 95370-2824
Mailing address
PO Box 939
Angels Camp, CA 95222-0939
Phone (209) 754-6262
Other names
- Janet L Black-Rourke
Other providers in Sonora, CA
- Elizabeth M Beutter
- Vinod C Bhan
- Linda Lee Bibbs
- William H. Birtwhistle
- Charles Henry Black IV
- Jeanina Bloom
- Karen Maureen Blum
- Bob'S Greenley Pharmacy Inc
- Tristen R Bogue
- David Bohannon
All providers in Sonora, CA · Clinical Social Worker in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 12, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.