Active NPI
Michael Myette
- Clinical Social Worker
- San Pablo, CA
National Provider Identifier
1902054240
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW61055
- Practice address
- 2523 El Portal Dr
San Pablo, CA 94806-3305 - Phone
- (510) 439-3130
- Fax
- (510) 439-3129
- NPI assigned
- Aug 28, 2008
- Last updated
- May 21, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCSW61055 | CA | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X | NU |
Addresses
Primary practice location
2523 El Portal Dr
San Pablo, CA 94806-3305
Mailing address
586 Kenmore Ave
Oakland, CA 94610-1631
Phone (760) 914-0093
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW61055 | CA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fred Finch Youth Center | Clinical | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1432166400000",
"number": "1902054240",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "586 KENMORE AVE",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946101631",
"telephone_number": "760-914-0093"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2523 EL PORTAL DR",
"city": "SAN PABLO",
"state": "CA",
"postal_code": "948063305",
"telephone_number": "510-439-3130",
"fax_number": "510-439-3129"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MYETTE",
"first_name": "MICHAEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-08-28",
"last_updated": "2015-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCSW61055",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Pablo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 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.