Individual provider Active NPI

Cynthia Lea Nesiba, LCSW

  • Clinical Social Worker
  • Eugene, OR
National Provider Identifier
1861665614
Registry record updated May 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
L6819 Issued in OR
Practice address
1077 Chambers St
Ste 2
Eugene, OR 97402-3706
Phone
(402) 984-3004
NPI assigned
Apr 11, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2019

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 3529 NE
Mental Health Counselor 101YM0800X L6819 OR
Clinical Social Worker 1041C0700X 1321 NE
Clinical Social Worker 1041C0700X L6819 OR Primary
Mental Health Counselor 101YM0800X 8102 NE

Addresses

Primary practice location

1077 Chambers St
Ste 2
Eugene, OR 97402-3706

Mailing address

1077 Chambers St
Ste 2
Eugene, OR 97402-3706
Phone (541) 342-8437

Other identifiers 1

IdentifierTypeStateIssuer
10025173100MedicaidNE

Other names 1

  • Cynthia McGrath Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20160601001328 OR Practitioner - Clinical Social Worker 5991999112 Reassigns benefits to 1 organization
Practice locations: Eugene, OR

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
L6819ORMDClinical Social Worker
8102NEMDGeneral Practice Dentistry
1321NEMDPharmacy Technician
3529NEMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Roseburg Therapy LLC Mental Health CurrentSince Jul 7, 2019 Accepting new patients

Locations

272 NW Medical Loop
Ste E
Roseburg, OR 97471
Phone (541) 677-6141

Organizations & group practices 1

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": "1207872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558483200000",
    "number": "1861665614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1077 CHAMBERS ST",
            "address_2": "STE 2",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974023706",
            "telephone_number": "541-342-8437",
            "fax_number": "458-201-7150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1077 CHAMBERS ST",
            "address_2": "STE 2",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974023706",
            "telephone_number": "402-984-3004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NESIBA",
        "first_name": "CYNTHIA",
        "middle_name": "LEA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-11",
        "last_updated": "2019-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NE",
            "license": "3529",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "L6819",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NE",
            "license": "1321",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L6819",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NE",
            "license": "8102",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025173100",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CYNTHIA",
            "last_name": "MCGRATH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Eugene, OR

Sources for this page

Verify at the official NPI Registry.