Individual provider Active NPI

Theresa Nicole Jones

  • Clinical Social Worker
  • Hemet, CA
National Provider Identifier
1205244175
Registry record updated Dec 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW92277 Issued in CA
Practice address
39990 Faure Rd
Hemet, CA 92544-9408
Phone
(951) 708-4019
NPI assigned
Jul 23, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LCSW92277 CA Primary

Addresses

Primary practice location

39990 Faure Rd
Hemet, CA 92544-9408

Mailing address

780 E. Gilbert Street
San Bernardino, CA 92415
Phone (909) 387-7089

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230216002589 CA Practitioner - Clinical Social Worker 3779955976 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCSW92277CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Cognitive Care Solutions Group Inc CurrentSince Jan 8, 2023 Accepting new patients

Locations

3943 Irvine Blvd
Irvine, CA 92602
Phone (714) 922-0120

23461 S Pointe Dr
Ste 240
Laguna Hills, CA 92653
Phone (714) 545-3390

27350 Nicolas Rd
Temecula, CA 92591
Phone (714) 545-3390

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.

NPI Registry JSON

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

{
    "created_epoch": "1406073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640736000000",
    "number": "1205244175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "780 E. GILBERT STREET",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "92415",
            "telephone_number": "909-387-7089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39990 FAURE RD",
            "city": "HEMET",
            "state": "CA",
            "postal_code": "925449408",
            "telephone_number": "951-708-4019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JONES",
        "first_name": "THERESA",
        "middle_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-23",
        "last_updated": "2021-12-29",
        "certification_date": "2021-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW92277",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hemet, CA

Sources for this page

Verify at the official NPI Registry.