Active NPI
Krystal Mi'Chal Gordon, LCSW
- Clinical Social Worker
- Compton, CA
National Provider Identifier
1366513012
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCS 29762
- Practice address
- 546 W Compton Blvd
Compton, CA 90220-3011 - Phone
- (310) 885-2117
- Fax
- (310) 537-9653
- NPI assigned
- Nov 13, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Practitioner | 225400000X | ASW20095 | CA | |
| Clinical Social Worker | 1041C0700X | LCS 29762 | CA | Primary |
Addresses
Primary practice location
546 W Compton Blvd
Compton, CA 90220-3011
Mailing address
PO Box 3044
Lakewood, CA 90711-3044
Phone (310) 885-2117
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 |
|---|---|---|---|
| LCS 29762 | CA | MD | Clinical Social Worker |
| ASW20095 | CA | MD | Rehabilitation Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1380844800000",
"number": "1366513012",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3044",
"city": "LAKEWOOD",
"state": "CA",
"postal_code": "907113044",
"telephone_number": "310-885-2117",
"fax_number": "310-537-9653"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "546 W COMPTON BLVD",
"city": "COMPTON",
"state": "CA",
"postal_code": "902203011",
"telephone_number": "310-885-2117",
"fax_number": "310-537-9653"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "KRYSTAL",
"middle_name": "MI'CHAL",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-13",
"last_updated": "2013-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": "CA",
"license": "ASW20095",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCS 29762",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Compton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.