Individual provider Active NPI

Sandra Jill Allen, LCSW

  • Social Worker
  • Los Angeles, CA
National Provider Identifier
1255463097
Registry record updated Jul 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
16889 Issued in CA
Practice address
11301 Wilshire Blvd BLDG 206
Room 33
Los Angeles, CA 90073-1003
Phone
(310) 478-3711
Fax
(310) 268-4378
NPI assigned
Mar 9, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 16889 CA Primary

Addresses

Primary practice location

11301 Wilshire Blvd BLDG 206
Room 33
Los Angeles, CA 90073-1003

Mailing address

11301 Wilshire Blvd BLDG 206
Room 33
Los Angeles, CA 90073-1003
Phone (310) 478-3711

Other practice location 1

444 W Fort St. Fl 2
Boise, ID 83702-4535
Phone (208) 422-1018

Other names 1

  • Sandra Jill Davidson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
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.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
16889CAMDOccupational Therapist

NPI Registry JSON

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690502400000",
    "number": "1255463097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11301 WILSHIRE BLVD BLDG 206",
            "address_2": "ROOM 33",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900731003",
            "telephone_number": "310-478-3711",
            "fax_number": "310-268-4378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11301 WILSHIRE BLVD BLDG 206",
            "address_2": "ROOM 33",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900731003",
            "telephone_number": "310-478-3711",
            "fax_number": "310-268-4378"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "444 W Fort St. Fl 2",
            "address_purpose": "LOCATION",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837024535",
            "country_code": "US",
            "telephone_number": "208-422-1018",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ALLEN",
        "first_name": "SANDRA",
        "middle_name": "JILL",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-09",
        "last_updated": "2023-07-28",
        "certification_date": "2023-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CA",
            "license": "16889",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SANDRA",
            "last_name": "DAVIDSON",
            "middle_name": "JILL",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.