Individual provider Active NPI

Lourdes Ortega Miranda, LCSW

  • Clinical Social Worker
  • Gardena, CA
National Provider Identifier
1083962096
Registry record updated Aug 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
81660 Issued in CA
Practice address
1045 W Redondo Beach Blvd Ste 300
Gardena, CA 90247-4175
Phone
(323) 241-6730
NPI assigned
Aug 22, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 21, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X ASW66105 CA
Clinical Social Worker 1041C0700X 81660 CA Primary

Addresses

Primary practice location

1045 W Redondo Beach Blvd Ste 300
Gardena, CA 90247-4175

Mailing address

1045 W Redondo Beach Blvd Ste 300
Gardena, CA 90247-4175
Phone (323) 241-6730

Other identifiers 4

IdentifierTypeStateIssuer
7184OtherCAMEDI-CAL
7667OtherCAMEDI-CAL
7708OtherCAMEDI-CAL
7368OtherCAMEDI-CAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180613002484 CA Practitioner - Clinical Social Worker 2567717689 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Los Angeles County Department of Mental HealthGroup PAC ID 7416869896, 294 clinicians

Practice addresses (Care Compare)

2311 W El Segundo Blvd
South Bay MHS
Hawthorne, CA 90250-3315
Phone (310) 241-6730

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ASW66105CAMDClinical Social Worker
81660CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Los Angeles County Department of Mental Health Current Accepting new patients
Los Angeles County Department of Mental Health CurrentSince May 5, 2018 Accepting new patients
Los Angeles County Department of Mental Health CurrentSince May 5, 2018 Accepting new patients
Amanecer Community Counseling Service, a Non-Profit Corporation PastSince Jul 1, 2022 Accepting new patients
Amanecer Community Counseling Service, a Non-Profit Corporation PastSince Mar 21, 2021 Accepting new patients

Locations

1045 W Redondo Beach Blvd
Ste 300
Gardena, CA 90247
Phone (310) 352-4170

10515 Balboa Blvd
Granada Hills, CA 91344
Phone (818) 486-3837

2311 W El Segundo Blvd
Hawthorne, CA 90250
Phone (310) 241-6730

510 S Vermont Ave
Fl 19
Los Angeles, CA 90020
Phone (213) 480-3416

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1345593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724198400000",
    "number": "1083962096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1045 W REDONDO BEACH BLVD STE 300",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902474175",
            "telephone_number": "323-241-6730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 W REDONDO BEACH BLVD STE 300",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902474175",
            "telephone_number": "323-241-6730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRANDA",
        "first_name": "LOURDES",
        "middle_name": "ORTEGA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-08-22",
        "last_updated": "2024-08-21",
        "certification_date": "2024-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "ASW66105",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "81660",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL",
            "identifier": "7184",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL",
            "identifier": "7667",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL",
            "identifier": "7708",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL",
            "identifier": "7368",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gardena, CA

Sources for this page

Verify at the official NPI Registry.