Active NPI
Larry Antonio Woodland, LCSW
- Clinical Social Worker
- Los Angeles, CA
National Provider Identifier
1164507349
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 63566
- Practice address
- 627 N Larchmont Blvd
Los Angeles, CA 90004-1307 - Phone
- (510) 387-7965
- Fax
- (213) 632-3192
- NPI assigned
- Oct 26, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 075802 | NY | |
| Clinical Social Worker | 1041C0700X | 63566 | CA | Primary |
Addresses
Primary practice location
627 N Larchmont Blvd
Los Angeles, CA 90004-1307
Mailing address
821 S Gramercy PL
Los Angeles, CA 90005-3449
Phone (510) 387-7965
Other practice location 1
821 S Gramercy Pl
Los Angeles, CA 90005-3449
Phone (510) 387-7965
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 83-2560750 | Medicaid | CA |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Catholic Charities Neighborhood Services, Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Brooklyn, NY
- NPI 1548373921
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692576000000",
"number": "1164507349",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "821 S GRAMERCY PL",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900053449",
"telephone_number": "510-387-7965",
"fax_number": "213-632-3192"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "627 N LARCHMONT BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900041307",
"telephone_number": "510-387-7965",
"fax_number": "213-632-3192"
}
],
"practiceLocations": [
{
"address_1": "821 S Gramercy Pl",
"address_purpose": "LOCATION",
"city": "Los Angeles",
"state": "CA",
"postal_code": "900053449",
"country_code": "US",
"telephone_number": "510-387-7965",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WOODLAND",
"first_name": "LARRY",
"middle_name": "ANTONIO",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-26",
"last_updated": "2023-08-21",
"certification_date": "2023-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "075802",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "63566",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "83-2560750",
"state": "CA"
}
],
"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 Aug 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.