Active NPI
Jennell Maze, LCSW
- Clinical Social Worker
- Los Angeles, CA
National Provider Identifier
1114090701
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW 26309
- Practice address
- 11080 W Olympic Blvd
Los Angeles, CA 90064-1937 - Phone
- (310) 966-6656
- NPI assigned
- Nov 15, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCSW 26309 | CA | Primary |
Addresses
Primary practice location
11080 W Olympic Blvd
Los Angeles, CA 90064-1937
Mailing address
31450 Broad Beach Rd.
Malibu, CA 90265
Phone (310) 430-8882
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 |
|---|---|---|---|
| LCSW 26309 | CA | MD | Clinical Social Worker |
| 26309 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1641859200000",
"number": "1114090701",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "31450 BROAD BEACH RD.",
"city": "MALIBU",
"state": "CA",
"postal_code": "90265",
"telephone_number": "310-430-8882"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11080 W OLYMPIC BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900641937",
"telephone_number": "310-966-6656"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAZE",
"first_name": "JENNELL",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-15",
"last_updated": "2022-01-11",
"certification_date": "2022-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCSW 26309",
"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 Jan 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.