Michael Anthony Bacallao, LMSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

115700 Issued in CA

Practice address

382 N McKelvy Ave Apt 202
Clovis, CA 93611-2410

Phone

(732) 425-5851

NPI assigned

Jan 12, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1515715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688601600000",
    "number": "1922516889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "64S MANOR CRES",
            "city": "NEW BRUNSWICK",
            "state": "NJ",
            "postal_code": "089011645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "382 N MCKELVY AVE APT 202",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936112410",
            "telephone_number": "732-425-5851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACALLAO",
        "first_name": "MICHAEL",
        "middle_name": "ANTHONY",
        "credential": "LMSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-01-12",
        "last_updated": "2023-07-06",
        "certification_date": "2023-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC06183100",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "115700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mercy Seyi Ayodele
• Yisel Ayon-Astorga
• Mark Ayoub, MD
• Leyla Mohassessy Azmoun, M.D.
• Jerrica Lee Shelby Babb
• Leslie A. Bacani, OD
• Sherie Rose Tayamen Bacarisa
• Khoeun Chhan Baeza
• Jennifer Irene Bague, LCSW
• Karla Bague

• Clinical Social Worker in Clovis, CA
• Providers in Clovis, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.