Active NPI
Stacy Angelic Jacobo
- Mental Health Counselor
- Los Angeles, CA
National Provider Identifier
1215580154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- ASW95529
- Practice address
- 333 S Beaudry Ave
Los Angeles, CA 90017-1466 - Phone
- (323) 241-3841
- NPI assigned
- Jul 19, 2019
- Last updated
- Jun 9, 2023
- 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 | ASW95529 | CA | Primary |
| Clinical Social Worker | 1041C0700X | NU | ||
| Student in an Organized Health Care Education/Training Program | 390200000X | NU |
Addresses
Primary practice location
333 S Beaudry Ave
Los Angeles, CA 90017-1466
Mailing address
333 S Beaudry Ave
Los Angeles, CA 90017-1466
Phone (323) 241-3841
Other practice location 1
3031 S Vermont Ave
Los Angeles, CA 90007-3033
Phone (323) 373-2400
Other practice location 2
4650 W Sunset Blvd # 53
Los Angeles, CA 90027-6062
Phone (323) 361-3849
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 |
|---|---|---|---|
| ASW95529 | CA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1563494400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686268800000",
"number": "1215580154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "333 S BEAUDRY AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900171466",
"telephone_number": "323-241-3841"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "333 S BEAUDRY AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900171466",
"telephone_number": "323-241-3841"
}
],
"practiceLocations": [
{
"address_1": "3031 S Vermont Ave",
"address_purpose": "LOCATION",
"city": "Los Angeles",
"state": "CA",
"postal_code": "900073033",
"country_code": "US",
"telephone_number": "323-373-2400",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4650 W Sunset Blvd # 53",
"address_purpose": "LOCATION",
"city": "Los Angeles",
"state": "CA",
"postal_code": "900276062",
"country_code": "US",
"telephone_number": "323-361-3849",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACOBO",
"first_name": "STACY",
"middle_name": "ANGELIC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-07-19",
"last_updated": "2023-06-09",
"certification_date": "2023-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "ASW95529",
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "NU",
"license": null,
"primary": false
}
],
"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 9, 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.