Individual provider Active NPI

Mayra Leticia Guerrero

  • Clinical Social Worker
  • Pasadena, CA
National Provider Identifier
1376978890
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW80223 Issued in CA
Practice address
940 Avenue 64
Pasadena, CA 91105-2711
Phone
(323) 543-2800
NPI assigned
Sep 4, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X ASW63940 CA
Social Worker 104100000X ASW63940 CA
Student in an Organized Health Care Education/Training Program 390200000X
Clinical Social Worker 1041C0700X LCSW80223 CA Primary

Addresses

Primary practice location

940 Avenue 64
Pasadena, CA 91105-2711

Mailing address

940 Avenue 64
Pasadena, CA 91105-2711
Phone (323) 543-2800

Other practice location 1

2309 Daly St
Los Angeles, CA 90031-2230
Phone (323) 222-4591

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
I20231017003201 CA Order and Referring Only - Clinical Social Worker 7719332394

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ASW63940CAMDSocial Worker
LCSW80223CAMDClinical Social Worker

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

NPI Registry JSON

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

{
    "created_epoch": "1378252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1376978890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "940 AVENUE 64",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911052711",
            "telephone_number": "323-543-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "940 AVENUE 64",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911052711",
            "telephone_number": "323-543-2800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2309 Daly St",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900312230",
            "country_code": "US",
            "telephone_number": "323-222-4591",
            "fax_number": "323-222-4614",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUERRERO",
        "first_name": "MAYRA",
        "middle_name": "LETICIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-04",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "ASW63940",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CA",
            "license": "ASW63940",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW80223",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pasadena, CA

Sources for this page

Verify at the official NPI Registry.