Active NPI
Mark Gillogly, MSW, LCSW
- Clinical Social Worker
- San Francisco, CA
National Provider Identifier
1891186623
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 16400
- Practice address
- 236 West Portal Avenue
Box 295
San Francisco, CA 94127-1423 - Phone
- (415) 418-0630
- NPI assigned
- Feb 16, 2015
- Last updated
- Feb 16, 2015
- Sex
- Male
- Sole proprietor
- No
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 | 16400 | CA | Primary |
Addresses
Primary practice location
236 West Portal Avenue
Box 295
San Francisco, CA 94127-1423
Mailing address
236 West Portal Avenue
Box 295
San Francisco, CA 94127-1423
Phone (415) 418-0630
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 16400 | Other | CA | BOARD OF BEHAVIORAL EXAMINERS, STATE OF CA DEPARTMENT OF CONSUMER AFFAIRS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16400 | CA | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1424044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424044800000",
"number": "1891186623",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "236 WEST PORTAL AVENUE",
"address_2": "BOX 295",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941271423",
"telephone_number": "415-418-0630"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "236 WEST PORTAL AVENUE",
"address_2": "BOX 295",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941271423",
"telephone_number": "415-418-0630"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLOGLY",
"first_name": "MARK",
"credential": "MSW, LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-02-16",
"last_updated": "2015-02-16",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "16400",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOARD OF BEHAVIORAL EXAMINERS, STATE OF CA DEPARTMENT OF CONSUMER AFFAIRS",
"identifier": "16400",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Francisco, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.