Active NPI
Jill Velasco Pena
- Clinical Social Worker
- Los Angeles, CA
National Provider Identifier
1184178501
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 109640
- Practice address
- 222 S Hill St FL 4
Los Angeles, CA 90012-3508 - Phone
- (213) 568-7940
- NPI assigned
- Aug 15, 2016
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 77918 | CA | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Clinical Social Worker | 1041C0700X | 109640 | CA | Primary |
Addresses
Primary practice location
222 S Hill St FL 4
Los Angeles, CA 90012-3508
Mailing address
222 S Hill St FL 4
Los Angeles, CA 90012-3508
Phone (213) 568-7940
Other practice location 1
9808 Venice Blvd
Ste. 505
Culver City, CA 90232-2732
Phone (310) 945-3350
Other practice location 2
1000 W Carson St # 498
Torrance, CA 90502-2004
Phone (310) 222-3110
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 |
|---|---|---|---|
| 77918 | CA | MD | Mental Health Counselor |
| 109640 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1471219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663027200000",
"number": "1184178501",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "222 S HILL ST FL 4",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900123508",
"telephone_number": "213-568-7940"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "222 S HILL ST FL 4",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900123508",
"telephone_number": "213-568-7940"
}
],
"practiceLocations": [
{
"address_1": "9808 Venice Blvd",
"address_2": "Ste. 505",
"address_purpose": "LOCATION",
"city": "Culver City",
"state": "CA",
"postal_code": "902322732",
"country_code": "US",
"telephone_number": "310-945-3350",
"fax_number": "310-945-3356",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1000 W Carson St # 498",
"address_purpose": "LOCATION",
"city": "Torrance",
"state": "CA",
"postal_code": "905022004",
"country_code": "US",
"telephone_number": "310-222-3110",
"fax_number": "310-328-7217",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "VELASCO PENA",
"first_name": "JILL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-08-15",
"last_updated": "2022-09-13",
"certification_date": "2022-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "77918",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "109640",
"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 Sep 13, 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.