Active NPI
Mary Victoria Booth, LCSW
- Clinical Social Worker
- Sacramento, CA
National Provider Identifier
1972778793
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCS6313
- Practice address
- 2015 21St St
104
Sacramento, CA 95818-1752 - Phone
- (916) 451-0310
- NPI assigned
- Apr 23, 2008
- Last updated
- Oct 5, 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 | LCS6313 | CA | Primary |
Addresses
Primary practice location
2015 21St St
104
Sacramento, CA 95818-1752
Mailing address
2015 21St St
104
Sacramento, CA 95818-1752
Phone (916) 451-0310
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, 2013 through Jul 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCS6313 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1208908800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1286236800000",
"number": "1972778793",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2015 21ST ST",
"address_2": "104",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958181752",
"telephone_number": "916-451-0310"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2015 21ST ST",
"address_2": "104",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958181752",
"telephone_number": "916-451-0310"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOOTH",
"first_name": "MARY",
"middle_name": "VICTORIA",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-04-23",
"last_updated": "2010-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCS6313",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 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.