Active NPI
Jessica R Polk, LCSW
- Clinical Social Worker
- Compton, CA
National Provider Identifier
1477715340
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW 74433
- Practice address
- 2010 E El Segundo Blvd
Compton, CA 90222-7109 - Phone
- (310) 637-0917
- Fax
- (310) 637-0473
- NPI assigned
- Jul 1, 2008
- Last updated
- Nov 14, 2016
- 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 | LCSW 74433 | CA | Primary |
Addresses
Primary practice location
2010 E El Segundo Blvd
Compton, CA 90222-7109
Mailing address
2610 Industry Way
Lynwood, CA 90262-4283
Phone (310) 631-8004
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 |
|---|---|---|---|
| LCSW 74433 | CA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern California Health & Rehabilitation Program | Past | Accepting new patients |
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.
-
- Community/Behavioral Health Agency
- Lynwood, CA
- NPI 1467775221
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214870400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1479081600000",
"number": "1477715340",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2610 INDUSTRY WAY",
"city": "LYNWOOD",
"state": "CA",
"postal_code": "902624283",
"telephone_number": "310-631-8004",
"fax_number": "310-637-0473"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2010 E EL SEGUNDO BLVD",
"city": "COMPTON",
"state": "CA",
"postal_code": "902227109",
"telephone_number": "310-637-0917",
"fax_number": "310-637-0473"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLK",
"first_name": "JESSICA",
"middle_name": "R",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-07-01",
"last_updated": "2016-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCSW 74433",
"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 Nov 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.