Gina Michelle Carrillo-Jackman, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

21810 Issued in CA

Practice address

6193 Barons Way
Oak Park, CA 91377-5849

Phone

(818) 584-6395

NPI assigned

Feb 10, 2023

Last updated

Feb 10, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1675987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675987200000",
    "number": "1053018911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5737 KANAN RD # 438",
            "city": "AGOURA",
            "state": "CA",
            "postal_code": "913011601",
            "telephone_number": "818-854-0081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6193 BARONS WAY",
            "city": "OAK PARK",
            "state": "CA",
            "postal_code": "913775849",
            "telephone_number": "818-584-6395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARRILLO-JACKMAN",
        "first_name": "GINA",
        "middle_name": "MICHELLE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-02-10",
        "last_updated": "2023-02-10",
        "certification_date": "2023-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "21810",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Oak Park, CA
• Providers in Oak Park, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2023; 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.