Active NPI
Rachel Len Koutnik, LCSW
- Clinical Social Worker
- Culver City, CA
National Provider Identifier
1508154865
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW78677
- Practice address
- 4760 Sepulveda Blvd
Culver City, CA 90230-4820 - Phone
- (310) 390-6612
- Fax
- (310) 398-5690
- NPI assigned
- Jul 20, 2011
- 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 | LCSW78677 | CA | Primary |
Addresses
Primary practice location
4760 Sepulveda Blvd
Culver City, CA 90230-4820
Mailing address
4760 Sepulveda Blvd
Culver City, CA 90230-4820
Phone (310) 390-6612
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1616824 | Other | IL | BLUE SHIELD |
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 |
|---|---|---|---|
| LCSW78677 | CA | MD | Clinical Social Worker |
| 78677 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1311120000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1512086400000",
"number": "1508154865",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4760 SEPULVEDA BLVD",
"city": "CULVER CITY",
"state": "CA",
"postal_code": "902304820",
"telephone_number": "310-390-6612",
"fax_number": "310-398-5690"
},
{
"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",
"fax_number": "310-398-5690"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOUTNIK",
"first_name": "RACHEL",
"middle_name": "LEN",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-07-20",
"last_updated": "2017-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCSW78677",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "1616824",
"state": "IL"
}
],
"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 Dec 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.