Individual provider Active NPI

Jessica Paola Gomez Lezama, MSW, ASW

  • Clinical Social Worker
  • Truckee, CA
National Provider Identifier
1427524974
Registry record updated Sep 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
102176 Issued in CA
Practice address
10775 Pioneer TRL Ste 215
Truckee, CA 96161-0234
Phone
(415) 424-4266
Fax
(415) 520-6633
NPI assigned
Oct 22, 2018
Last updated
Sep 25, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU
Clinical Social Worker 1041C0700X 102176 CA Primary

Addresses

Primary practice location

10775 Pioneer TRL Ste 215
Truckee, CA 96161-0234

Mailing address

8300 Esters Blvd Ste 900
Irving, TX 75063-2233
Phone (415) 424-4266

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
I20260609004496 CA Practitioner - Clinical Social Worker 2769953769 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2021
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1515 Wilshire Blvd Apt
Suite 443
Los Angeles, CA 90017-3021

16255 Ventura Blvd
Suite 509
Encino, CA 91436-2305

PO Box
Suite 10365
Glendale, CA 91209-3365

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
102176CAMDClinical Social Worker

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1540166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695600000000",
    "number": "1427524974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8300 ESTERS BLVD STE 900",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750632233",
            "telephone_number": "415-424-4266",
            "fax_number": "415-520-6633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10775 PIONEER TRL STE 215",
            "city": "TRUCKEE",
            "state": "CA",
            "postal_code": "961610234",
            "telephone_number": "415-424-4266",
            "fax_number": "415-520-6633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOMEZ LEZAMA",
        "first_name": "JESSICA",
        "middle_name": "PAOLA",
        "credential": "MSW, ASW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-22",
        "last_updated": "2023-09-25",
        "certification_date": "2023-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "102176",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Truckee, CA

Sources for this page

Verify at the official NPI Registry.