Individual provider Active NPI

Crystal Veronica Segura, MSW, LCSW 90323

  • Clinical Social Worker
  • Madera, CA
National Provider Identifier
1861740052
Registry record updated Mar 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW90323 Issued in CA
Practice address
209 E 7TH St
Madera, CA 93638-3780
Phone
(559) 673-3580
Fax
(559) 661-2818
NPI assigned
Aug 21, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X
Mental Health Counselor 101YM0800X ASW36809 CA
Clinical Social Worker 1041C0700X LCSW90323 CA Primary

Addresses

Primary practice location

209 E 7TH St
Madera, CA 93638-3780

Mailing address

PO Box 1288
Madera, CA 93639-1288
Phone (559) 673-3508

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20191213000859 CA Practitioner - Clinical Social Worker 2860825387 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ASW36809CAMDMental Health Counselor
LCSW90323CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
County of Madera CurrentSince May 2, 2024 Accepting new patients

Locations

209 E 7th St
Madera, CA 93638
Phone (559) 395-0451

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": "1345507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709596800000",
    "number": "1861740052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1288",
            "city": "MADERA",
            "state": "CA",
            "postal_code": "936391288",
            "telephone_number": "559-673-3508",
            "fax_number": "559-675-7758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 E 7TH ST",
            "city": "MADERA",
            "state": "CA",
            "postal_code": "936383780",
            "telephone_number": "559-673-3580",
            "fax_number": "559-661-2818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEGURA",
        "first_name": "CRYSTAL",
        "middle_name": "VERONICA",
        "credential": "MSW, LCSW 90323",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-21",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "ASW36809",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW90323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madera, CA

Sources for this page

Verify at the official NPI Registry.