Active NPI
Ebony Medina Watson
- Social Worker
- Cypress, CA
National Provider Identifier
1376041582
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 125893
- Practice address
- 10601 Walker St Ste 170
Cypress, CA 90630-4759 - Phone
- (248) 765-8679
- NPI assigned
- Jan 23, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 6801115599 | MI | |
| Social Worker | 104100000X | 125893 | CA | Primary |
Addresses
Primary practice location
10601 Walker St Ste 170
Cypress, CA 90630-4759
Mailing address
PO Box 128
Manhattan Beach, CA 90267-0128
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 |
|---|---|---|---|
| 125893 | CA | MD | Social Worker |
| 6801115599 | MI | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1516665600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1778803200000",
"number": "1376041582",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 128",
"city": "MANHATTAN BEACH",
"state": "CA",
"postal_code": "902670128"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10601 WALKER ST STE 170",
"city": "CYPRESS",
"state": "CA",
"postal_code": "906304759",
"telephone_number": "248-765-8679"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATSON",
"first_name": "EBONY",
"middle_name": "MEDINA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-01-23",
"last_updated": "2026-05-15",
"certification_date": "2026-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MI",
"license": "6801115599",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "CA",
"license": "125893",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cypress, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.