Mallory Ruth Axelrod, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW72307 Issued in CA

Practice address

10929 South St Ste 214B
Cerritos, CA 90703-5374

Phone

(562) 924-5526

NPI assigned

Jan 7, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Mallory Ruth Gamer Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Community Family Guidance Center

  • Community/Behavioral Health Agency
  • Cerritos, CA
  • NPI 1922136076
  NPD (past)

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

{
    "created_epoch": "1452124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574208000000",
    "number": "1073979936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5994 MYRTLE AVE",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908053515",
            "telephone_number": "224-619-2640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10929 SOUTH ST STE 214B",
            "city": "CERRITOS",
            "state": "CA",
            "postal_code": "907035374",
            "telephone_number": "562-924-5526"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9047 Florence Ave Ste I",
            "address_purpose": "LOCATION",
            "city": "Downey",
            "state": "CA",
            "postal_code": "902403400",
            "country_code": "US",
            "telephone_number": "224-619-2640",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AXELROD",
        "first_name": "MALLORY",
        "middle_name": "RUTH",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-07",
        "last_updated": "2019-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.017634",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "ASW69967",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW72307",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1922136076",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MALLORY",
            "last_name": "GAMER",
            "middle_name": "RUTH",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Virginia Aviles-Corona
• Monic Zabrina Avina
• Yolanda Avitia
• Jolia S Awadallah
• Jenna Leigh Axelrod, PH.D.
• Jay Azling, DDS
• Francisco Licopit Badar III, MD
• Badii Lee Dental Corporation, Inc
• Linda Badillo
• Roshni A Badlani

• Clinical Social Worker in Cerritos, CA
• Providers in Cerritos, 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 Nov 20, 2019; 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.