NPIMap

Organization Active NPI

Clinical Social Work, PLLC

  • Clinical Social Worker
  • Pueblo, CO
National Provider Identifier
1962144667
Registry record updated Apr 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
CLINICAL SOCIAL WORK, PLLC
Practice address
3000 Wedgewood Dr # 2215
Pueblo, CO 81005-2300
Phone
(719) 900-5279
NPI assigned
Apr 12, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2022

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

Authorized official

Name
Trevor Gates-Crandall, PHDNPI 1316982705
Title
LCSW
Phone
(719) 900-5279

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

3000 Wedgewood Dr # 2215
Pueblo, CO 81005-2300

Mailing address

3000 Wedgewood Dr # 2215
Pueblo, CO 81005-2300
Phone (719) 900-5279

National Provider Directory

National Provider Directory

Locations

3000 Wedgewood Dr
#2215
Pueblo, CO 81005
Phone (719) 900-5279

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1649721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649721600000",
    "number": "1962144667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 WEDGEWOOD DR # 2215",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810052300",
            "telephone_number": "719-900-5279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 WEDGEWOOD DR # 2215",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810052300",
            "telephone_number": "719-900-5279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICAL SOCIAL WORK, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-12",
        "last_updated": "2022-04-12",
        "certification_date": "2022-04-12",
        "status": "A",
        "authorized_official_last_name": "GATES-CRANDALL",
        "authorized_official_first_name": "TREVOR",
        "authorized_official_title_or_position": "LCSW",
        "authorized_official_telephone_number": "719-900-5279",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2022; 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.