Active NPI
Jacqueline Cuellar Bravo, LCSW
- Clinical Social Worker
- Los Angeles, CA
National Provider Identifier
1104043819
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 70155
- Practice address
- 600 St Paul Ave
Suite 200
Los Angeles, CA 90017-2038 - Phone
- (213) 482-6400
- NPI assigned
- Apr 20, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 26898 | CA | |
| Clinical Social Worker | 1041C0700X | 70155 | CA | Primary |
Addresses
Primary practice location
600 St Paul Ave
Suite 200
Los Angeles, CA 90017-2038
Mailing address
600 St Paul Ave
Suite 200
Los Angeles, CA 90017-2038
Phone (213) 482-6400
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26898 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1451520000000",
"number": "1104043819",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "600 ST PAUL AVE",
"address_2": "SUITE 200",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900172038",
"telephone_number": "213-482-6400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 ST PAUL AVE",
"address_2": "SUITE 200",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900172038",
"telephone_number": "213-482-6400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRAVO",
"first_name": "JACQUELINE",
"middle_name": "CUELLAR",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-20",
"last_updated": "2015-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "CA",
"license": "26898",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "70155",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.