Active NPI
Cody Jean, LCSW
- Clinical Social Worker
- Tracy, CA
National Provider Identifier
1043896202
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- CSW007304
- Practice address
- 2655 Henley Pkwy Unit 7722
Tracy, CA 95377-2238 - Phone
- (678) 789-6109
- NPI assigned
- Mar 18, 2021
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | CSW007304 | GA | |
| Clinical Social Worker | 1041C0700X | CSW007304 | GA | Primary |
Addresses
Primary practice location
2655 Henley Pkwy Unit 7722
Tracy, CA 95377-2238
Mailing address
2455 Naglee Rd # 110
Tracy, CA 95304-7324
Phone (678) 789-6109
Other practice location 1
1425 McFarland Ave
Rossville, GA 30741-2215
Phone (800) 275-3243
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Tracy | Direct |
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1616025600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1629158400000",
"number": "1043896202",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2455 NAGLEE RD # 110",
"city": "TRACY",
"state": "CA",
"postal_code": "953047324",
"telephone_number": "678-789-6109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2655 HENLEY PKWY UNIT 7722",
"city": "TRACY",
"state": "CA",
"postal_code": "953772238",
"telephone_number": "678-789-6109"
}
],
"practiceLocations": [
{
"address_1": "1425 McFarland Ave",
"address_purpose": "LOCATION",
"city": "Rossville",
"state": "GA",
"postal_code": "307412215",
"country_code": "US",
"telephone_number": "800-275-3243",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JEAN",
"first_name": "CODY",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-03-18",
"last_updated": "2021-08-17",
"certification_date": "2021-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "GA",
"license": "CSW007304",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "GA",
"license": "CSW007304",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "Tracy",
"affiliation": "N",
"endpointDescription": "Couseling",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "2655 Henley Pkwy Unit 7722",
"city": "Tracy",
"state": "CA",
"country_code": "US",
"postal_code": "953772238",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Tracy, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.