Rickie Inez Berrett Lake, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

139965-3501 Issued in UT

Practice address

5965 S 900 E
Salt Lake City, UT 84121-1720

Phone

(801) 263-7225

Fax

(801) 263-7279

NPI assigned

Jan 27, 2006

Last updated

Nov 19, 2010By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Ms. Rickie Berrett Lundstrom Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Valley Behavioral Health Incorporated

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • West Valley City, UT
  • NPI 1932166980

  Clinical

  NPD (past)

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

{
    "created_epoch": "1138320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1290124800000",
    "number": "1942271028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5576 ALPINE POINT CIR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841189275",
            "telephone_number": "801-835-3511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5965 S 900 E",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841211720",
            "telephone_number": "801-263-7225",
            "fax_number": "801-263-7279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE",
        "first_name": "RICKIE",
        "middle_name": "INEZ BERRETT",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-27",
        "last_updated": "2010-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "139965-3501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EDUCATORS MUTUAL",
            "identifier": "942938348LA1",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DESERT MUTUAL",
            "identifier": "262030",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS",
            "identifier": "942938348",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INTERMOUNTAIN HEALTH CARE",
            "identifier": "107001381101",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RICKIE",
            "last_name": "LUNDSTROM",
            "middle_name": "BERRETT",
            "prefix": "MS.",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Naomi Ruth Laird, PA-C
• Farah Laiwalla
• Lauren N. Lajos, MD
• Elaine Lake, MA CCC-SLP
• Lorri K Lake, CPCI
• Kathleen Fitzwilliam Lakey, LCSW
• Ashwin Kumar Lal, M.D.
• Chitra Lal Lal, MD
• Ta'Alefili Lalau
• Caroline Lalliss

• Clinical Social Worker in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Clinical Social Worker in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2010; 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.