Active NPI
Tina Stanley, L.C.S.W.
- Clinical Social Worker
- Sebastopol, CA
National Provider Identifier
1932439403
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCS 11453
- Practice address
- 934 Gaydee CT
Sebastopol, CA 95472-4611 - Phone
- (707) 829-8443
- NPI assigned
- Jan 6, 2010
- 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 | LCS 11453 | CA | Primary |
Addresses
Primary practice location
934 Gaydee CT
Sebastopol, CA 95472-4611
Mailing address
934 Gaydee CT
Sebastopol, CA 95472-4611
Phone (707) 829-8443
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jul 1, 2017 through Jul 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11453 | CA | MD | Addiction (Substance Use Disorder) Counselor |
| LCS 11453 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1262736000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1262736000000",
"number": "1932439403",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "934 GAYDEE CT",
"city": "SEBASTOPOL",
"state": "CA",
"postal_code": "954724611",
"telephone_number": "707-829-8443"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "934 GAYDEE CT",
"city": "SEBASTOPOL",
"state": "CA",
"postal_code": "954724611",
"telephone_number": "707-829-8443"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STANLEY",
"first_name": "TINA",
"credential": "L.C.S.W.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-01-06",
"last_updated": "2010-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCS 11453",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sebastopol, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2010; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.