Jennifer S.T. Blair, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

66431 Issued in CA

Practice address

11949 Jefferson Blvd
106
Culver City, CA 90230-6336

Phone

(323) 736-1463

NPI assigned

Nov 12, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Jennifer Sarah Thea Williamson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Oct 3, 2018 through Oct 3, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1447286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454198400000",
    "number": "1275906299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11949 JEFFERSON BLVD",
            "address_2": "106",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902306336",
            "telephone_number": "323-736-1463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11949 JEFFERSON BLVD",
            "address_2": "106",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902306336",
            "telephone_number": "323-736-1463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAIR",
        "first_name": "JENNIFER",
        "middle_name": "S.T.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-11-12",
        "last_updated": "2016-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "66431",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "WILLIAMSON",
            "middle_name": "SARAH THEA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Courtney Jean Bitz, ACSW
• Barbara Black
• Tamala Black, LMFT#115219
• Ciara Chanel Woodard Blackwell
• Myisha Lalease Blackwell
• Theodora Blanchfield, AMFT
• Laura Blanco
• John Berenson Blanton, D.D.S.
• Sara Michelle Bleak
• Betsy E. Blechman, M.D.

• Clinical Social Worker in Culver City, CA
• Providers in Culver City, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2016; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.