Individual provider Active NPI

Marcia Lynn Wong, LCSW

  • Clinical Social Worker
  • Westlake Village, CA
National Provider Identifier
1275146987
Registry record updated Apr 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
99235 Issued in CA
Practice address
2277 N Westlake Blvd # 102
Westlake Village, CA 91362
Phone
(310) 497-8274
NPI assigned
Aug 24, 2020
Last updated
Apr 25, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 25, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 63227 CA
Clinical Social Worker 1041C0700X 99235 CA Primary

Addresses

Primary practice location

2277 N Westlake Blvd # 102
Westlake Village, CA 91362

Mailing address

80 Buckskin Rd
Bell Canyon, CA 91307-1123
Phone (818) 266-6280

Other practice location 1

80 Buckskin Rd
Bell Canyon, CA 91307-1123
Phone (818) 266-6280

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260327003304 CA Practitioner - Clinical Social Worker 6608351663 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1996
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

402 W Broadway
Suite 400
San Diego, CA 92101-3554

80 Buckskin Rd
Bell Canyon, CA 91307-1123

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
99235CAMDClinical Social Worker

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1598227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682380800000",
    "number": "1275146987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 BUCKSKIN RD",
            "city": "BELL CANYON",
            "state": "CA",
            "postal_code": "913071123",
            "telephone_number": "818-266-6280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2277 N WESTLAKE BLVD # 102",
            "city": "WESTLAKE VILLAGE",
            "state": "CA",
            "postal_code": "91362",
            "telephone_number": "310-497-8274"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "80 Buckskin Rd",
            "address_purpose": "LOCATION",
            "city": "Bell Canyon",
            "state": "CA",
            "postal_code": "913071123",
            "country_code": "US",
            "telephone_number": "818-266-6280",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WONG",
        "first_name": "MARCIA",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-24",
        "last_updated": "2023-04-25",
        "certification_date": "2023-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CA",
            "license": "63227",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "99235",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Westlake Village, CA

Sources for this page

Verify at the official NPI Registry.