Jeanette Churchill-Matillo, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCS8967 Issued in CA

Practice address

24726 Meridian Dr
Dana Point, CA 92629-1819

Phone

(949) 248-5599

Fax

(949) 248-5560

NPI assigned

Jul 3, 2007

Last updated

Jan 11, 2011By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1183420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294704000000",
    "number": "1194923003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24726 MERIDIAN DR",
            "city": "DANA POINT",
            "state": "CA",
            "postal_code": "926291819",
            "telephone_number": "949-248-5599",
            "fax_number": "949-248-5560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24726 MERIDIAN DR",
            "city": "DANA POINT",
            "state": "CA",
            "postal_code": "926291819",
            "telephone_number": "949-248-5599",
            "fax_number": "949-248-5560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHURCHILL-MATILLO",
        "first_name": "JEANETTE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-03",
        "last_updated": "2011-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS8967",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Dana Point, CA
• Providers in Dana Point, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2011; 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.