Active NPI
Dewey Lynn Bolen, LCSW
- Clinical Social Worker
- Redding, CA
National Provider Identifier
1881753200
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCS18863
- Practice address
- 2469 Old Eureka Way
Redding, CA 96001-0336 - Phone
- (530) 243-2575
- Fax
- (530) 244-9899
- NPI assigned
- Dec 8, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCS18863 | CA | Primary |
Addresses
Primary practice location
2469 Old Eureka Way
Redding, CA 96001-0336
Mailing address
PO Box 9
McArthur, CA 96056-0009
Phone (530) 243-2575
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LCS18863 | Other | CA | STATE LICENSE NUMBER |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070627000235 | CA | Practitioner - Clinical Social Worker | 9335248681 | Practice locations: Redding, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 1987
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
2469 Old Eureka Way
Redding, CA 96001-0336
Phone (530) 243-2575
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCS18863 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165536000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1881753200",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 9",
"city": "MCARTHUR",
"state": "CA",
"postal_code": "960560009",
"telephone_number": "530-243-2575",
"fax_number": "530-244-9899"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2469 OLD EUREKA WAY",
"city": "REDDING",
"state": "CA",
"postal_code": "960010336",
"telephone_number": "530-243-2575",
"fax_number": "530-244-9899"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLEN",
"first_name": "DEWEY",
"middle_name": "LYNN",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-08",
"last_updated": "2022-07-21",
"certification_date": "2021-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCS18863",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE NUMBER",
"identifier": "LCS18863",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Redding, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.