Individual provider Active NPI

Andrew Calvin Hudson

  • Clinical Social Worker
  • San Bernardino, CA
National Provider Identifier
1962015677
Registry record updated Jul 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
132365 Issued in CA
Practice address
290 N D St Ste 700
San Bernardino, CA 92401-1705
Phone
(909) 963-5355
NPI assigned
Aug 24, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X
Social Worker 104100000X 97209 CA
Mental Health Counselor 101YM0800X 97209 CA
Clinical Social Worker 1041C0700X 132365 CA Primary

Addresses

Primary practice location

290 N D St Ste 700
San Bernardino, CA 92401-1705

Mailing address

290 N D St Ste 700
San Bernardino, CA 92401-1705
Phone (909) 963-5355

Other practice location 1

2940 Summit St Ste 2D
Oakland, CA 94609-3416
Phone (510) 394-2008

Other practice location 2

14677 Merrill Ave
Fontana, CA 92335-4219
Phone (951) 643-2340

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

LicenseStateTypeSpecialty
97209CAMDSocial Worker
132365CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Step Up on Second Street Inc. CurrentSince Apr 20, 2025 Accepting new patients
Alondra Loya CurrentSince Jun 15, 2025 Accepting new patients

Locations

14677 Merrill Ave
Fontana, CA 92335
Phone (951) 643-2335

290 N D St
Ste 700
San Bernardino, CA 92401
Phone (909) 963-5355

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1598227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753401600000",
    "number": "1962015677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "290 N D ST STE 700",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924011705",
            "telephone_number": "909-963-5355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "290 N D ST STE 700",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924011705",
            "telephone_number": "909-963-5355"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2940 Summit St Ste 2D",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "CA",
            "postal_code": "946093416",
            "country_code": "US",
            "telephone_number": "510-394-2008",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14677 Merrill Ave",
            "address_purpose": "LOCATION",
            "city": "Fontana",
            "state": "CA",
            "postal_code": "923354219",
            "country_code": "US",
            "telephone_number": "951-643-2340",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HUDSON",
        "first_name": "ANDREW",
        "middle_name": "CALVIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-24",
        "last_updated": "2025-07-25",
        "certification_date": "2025-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CA",
            "license": "97209",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "97209",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "132365",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bernardino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2025; 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.