Active NPI
Brenda Kaye Ingram, L.C.S.W
- Clinical Social Worker
- Culver City, CA
National Provider Identifier
1407974397
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCS11609
- Practice address
- 4760 Sepulveda Blvd
Culver City, CA 90230-4820 - Phone
- (310) 390-6612
- NPI assigned
- Mar 27, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCS11609 | CA | Primary |
Addresses
Primary practice location
4760 Sepulveda Blvd
Culver City, CA 90230-4820
Mailing address
302 E 45TH St
Long Beach, CA 90807-1416
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCS11609 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174953600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1407974397",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "302 E 45TH ST",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908071416"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4760 SEPULVEDA BLVD",
"city": "CULVER CITY",
"state": "CA",
"postal_code": "902304820",
"telephone_number": "310-390-6612"
}
],
"practiceLocations": [],
"basic": {
"last_name": "INGRAM",
"first_name": "BRENDA",
"middle_name": "KAYE",
"credential": "L.C.S.W",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCS11609",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Culver City, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.