Active NPI
Jean Marie Willis, LCSW
- Clinical Social Worker
- Long Beach, CA
National Provider Identifier
1134360514
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 8383
- Practice address
- 5901 E 7TH St
Mail Code 122
Long Beach, CA 90822-5201 - Phone
- (562) 826-8000
- Fax
- (562) 826-5270
- NPI assigned
- Mar 16, 2009
- 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 | 8383 | CA | Primary |
Addresses
Primary practice location
5901 E 7TH St
Mail Code 122
Long Beach, CA 90822-5201
Mailing address
5901 E. 7TH Street
Mail Code 122
Long Beach, CA 90822
Phone (562) 826-8000
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8383 | CA | MD | Speech-Language Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1237161600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1329091200000",
"number": "1134360514",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5901 E. 7TH STREET",
"address_2": "MAIL CODE 122",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "90822",
"telephone_number": "562-826-8000",
"fax_number": "562-826-5270"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5901 E 7TH ST",
"address_2": "MAIL CODE 122",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908225201",
"telephone_number": "562-826-8000",
"fax_number": "562-826-5270"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "JEAN",
"middle_name": "MARIE",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-03-16",
"last_updated": "2012-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "8383",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Long Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.