Active NPI
Michael Nathan Humble, LCSW
- Clinical Social Worker
- San Jose, CA
National Provider Identifier
1972841641
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCS 22082
- Practice address
- 6332 Gondola Way
San Jose, CA 95120-3932 - Phone
- (209) 262-0305
- NPI assigned
- Jan 30, 2013
- Sex
- Male
- 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 22082 | CA | Primary |
Addresses
Primary practice location
6332 Gondola Way
San Jose, CA 95120-3932
Mailing address
6332 Gondola Way
San Jose, CA 95120-3932
Phone (209) 262-0305
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
| License | State | Type | Specialty |
|---|---|---|---|
| LCS 22082 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1359504000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1359504000000",
"number": "1972841641",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6332 GONDOLA WAY",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951203932",
"telephone_number": "209-262-0305"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6332 GONDOLA WAY",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951203932",
"telephone_number": "209-262-0305"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HUMBLE",
"first_name": "MICHAEL",
"middle_name": "NATHAN",
"name_prefix": "Dr.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-01-30",
"last_updated": "2013-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCS 22082",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.