Active NPI
Jeanett Del Carmen Carrillo, LCSW
- Clinical Social Worker
- North Hollywood, CA
National Provider Identifier
1134544885
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 109188
- Practice address
- 12157 Victory Blvd
North Hollywood, CA 91606-3204 - Phone
- (818) 755-8000
- NPI assigned
- Mar 4, 2014
- 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 | 109188 | CA | Primary |
Addresses
Primary practice location
12157 Victory Blvd
North Hollywood, CA 91606-3204
Mailing address
PO Box 55191
Sherman Oaks, CA 91413-0191
Phone (818) 472-0779
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221025003024 | CA | Order and Referring Only - Clinical Social Worker | 7911373410 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 109188 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1393891200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667347200000",
"number": "1134544885",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 55191",
"city": "SHERMAN OAKS",
"state": "CA",
"postal_code": "914130191",
"telephone_number": "818-472-0779"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12157 VICTORY BLVD",
"city": "NORTH HOLLYWOOD",
"state": "CA",
"postal_code": "916063204",
"telephone_number": "818-755-8000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARRILLO",
"first_name": "JEANETT",
"middle_name": "DEL CARMEN",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-03-04",
"last_updated": "2022-11-02",
"certification_date": "2022-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "109188",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Hollywood, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.