Active NPI
Jacqueline Andrea Deluca, LCSW113846
- Clinical Social Worker
- Los Angeles, CA
National Provider Identifier
1235638255
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 113846
- Practice address
- 4470 W Sunset Blvd Ste 107
Pmb94731
Los Angeles, CA 90027 - Phone
- (323) 968-6182
- Fax
- (833) 419-0181
- NPI assigned
- Feb 5, 2018
- 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 | ASW76857 | CA | |
| Psychologist | 103T00000X | |||
| Clinical Social Worker | 1041C0700X | 113846 | CA | Primary |
Addresses
Primary practice location
4470 W Sunset Blvd Ste 107
Pmb94731
Los Angeles, CA 90027
Mailing address
PO Box 2094
Mission Viejo, CA 92690-0094
Other practice location 1
55 Shaw Ave Ste 115
Clovis, CA 93612-3819
Phone (559) 825-1324
Other practice location 2
1600 M St
Fresno, CA 93721-1122
Phone (559) 487-1378
Other names 1
- Jacqueline Andrea Jacques
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260508002850 | CA | Practitioner - Clinical Social Worker | 8921576828 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2016
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
500 Westover Dr
Sanford, NC 27330-8941
PO Box
Suite 2094
Mission Viejo, CA 92690
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ASW76857 | CA | MD | Mental Health Counselor |
| 113846 | CA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Footsteps, a Licensed Clinical Social Worker Corporation | Mental Health | Past | Accepting new patients |
| Footsteps Behavioral Health Corporation | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Addiction Medicine (Psychiatry & Neurology) Physician
- Santa Clara, CA
- NPI 1972138238
CA
-
- Community/Behavioral Health Agency
- Clovis, CA
- NPI 1487038758
-
- Mental Health Counselor
- Clovis, CA
- NPI 1144720665
Mental Health
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1517788800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687132800000",
"number": "1235638255",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2094",
"city": "MISSION VIEJO",
"state": "CA",
"postal_code": "926900094"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4470 W SUNSET BLVD STE 107",
"address_2": "PMB94731",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90027",
"telephone_number": "323-968-6182",
"fax_number": "833-419-0181"
}
],
"practiceLocations": [
{
"address_1": "55 Shaw Ave Ste 115",
"address_purpose": "LOCATION",
"city": "Clovis",
"state": "CA",
"postal_code": "936123819",
"country_code": "US",
"telephone_number": "559-825-1324",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1600 M St",
"address_purpose": "LOCATION",
"city": "Fresno",
"state": "CA",
"postal_code": "937211122",
"country_code": "US",
"telephone_number": "559-487-1378",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DELUCA",
"first_name": "JACQUELINE",
"middle_name": "ANDREA",
"credential": "LCSW113846",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-02-05",
"last_updated": "2023-06-19",
"certification_date": "2023-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "ASW76857",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "113846",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JACQUELINE",
"last_name": "JACQUES",
"middle_name": "ANDREA",
"credential": "ASW76857",
"code": "1",
"type": "Former Name"
}
]
}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 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.