Individual provider Active NPI

Simone Nathanson

  • Clinical Social Worker
  • Los Angeles, CA
National Provider Identifier
1194085894
Registry record updated Jun 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW74001 Issued in CA
Practice address
11303 W Washington Blvd Ste 200
Los Angeles, CA 90066-6003
Phone
(310) 482-6600
Fax
(310) 313-0813
NPI assigned
May 29, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X
Clinical Social Worker 1041C0700X 33312 CA
Community Health Worker 172V00000X
Clinical Social Worker 1041C0700X LCSW74001 CA Primary

Addresses

Primary practice location

11303 W Washington Blvd Ste 200
Los Angeles, CA 90066-6003

Mailing address

1751 Cloverfield Blvd
Santa Monica, CA 90404-4007

Other practice location 1

4760 Sepulveda Blvd
Culver City, CA 90230-4820
Phone (310) 751-5350

Other practice location 2

1751 Cloverfield Blvd
Santa Monica, CA 90404-4007
Phone (310) 883-1220 ext. 136

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

LicenseStateTypeSpecialty
33312CAMDClinical Social Worker
LCSW74001CAMDClinical Social Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1338249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622505600000",
    "number": "1194085894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1751 CLOVERFIELD BLVD",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904044007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11303 W WASHINGTON BLVD STE 200",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900666003",
            "telephone_number": "310-482-6600",
            "fax_number": "310-313-0813"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4760 Sepulveda Blvd",
            "address_purpose": "LOCATION",
            "city": "Culver City",
            "state": "CA",
            "postal_code": "902304820",
            "country_code": "US",
            "telephone_number": "310-751-5350",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1751 Cloverfield Blvd",
            "address_purpose": "LOCATION",
            "city": "Santa Monica",
            "state": "CA",
            "postal_code": "904044007",
            "country_code": "US",
            "telephone_number": "310-883-1220 x136",
            "fax_number": "310-883-1223",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NATHANSON",
        "first_name": "SIMONE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-29",
        "last_updated": "2021-06-01",
        "certification_date": "2021-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "33312",
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW74001",
            "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 Jun 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.