Active NPI
Cheryl A. Procaccini
- Clinical Social Worker
- Newport Beach, CA
National Provider Identifier
1891454153
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCS20604
- Practice address
- 4540 Campus Dr Ste 107
Newport Beach, CA 92660-1815 - Phone
- (949) 510-7666
- NPI assigned
- Dec 14, 2021
- Sex
- Female
- 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 | LCS20604 | CA | Primary |
Addresses
Primary practice location
4540 Campus Dr Ste 107
Newport Beach, CA 92660-1815
Mailing address
1278 Glenneyre St # 171
Laguna Beach, CA 92651-3103
Phone (949) 510-7666
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Nov 14, 2023 through Nov 14, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCS20604 | CA | MD | Clinical Social Worker |
| 20604 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1639440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1639440000000",
"number": "1891454153",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1278 GLENNEYRE ST # 171",
"city": "LAGUNA BEACH",
"state": "CA",
"postal_code": "926513103",
"telephone_number": "949-510-7666"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4540 CAMPUS DR STE 107",
"city": "NEWPORT BEACH",
"state": "CA",
"postal_code": "926601815",
"telephone_number": "949-510-7666"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROCACCINI",
"first_name": "CHERYL",
"middle_name": "A.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-12-14",
"last_updated": "2021-12-14",
"certification_date": "2021-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCS20604",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newport Beach, CA
- Prime Surgical Center of Newport Beach, LLC
- Rayeonne Pritchett
- Private Physicians Medical Associates
- Private Physicians Medical Associates
- August Benjamin Privratsky Jr., PT, CP
- Judith Ruth Profant, PHD, CBSM
- Professional Partners Inc (Westcliff Compounding Pharmacy)
- Rosalie Ann Proffer, MA LMFT MARRIAGE FAM
- Prohealth Partners a Medical Group Inc
- Prosperity Wellness Inc
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.