Active NPI
Tracy Rene Overly
- Clinical Social Worker
- Los Angeles, CA
National Provider Identifier
1558918052
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 107652
- Practice address
- 515 Columbia Ave # 200
Los Angeles, CA 90017-1209 - Phone
- (213) 249-9388
- Fax
- (213) 389-7993
- NPI assigned
- Aug 20, 2019
- 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 | 107652 | CA | Primary |
Addresses
Primary practice location
515 Columbia Ave # 200
Los Angeles, CA 90017-1209
Mailing address
10 W Bay State St
P.O. Box 1104
Alhambra, CA 91802
Phone (626) 656-3431
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 |
|---|---|---|---|
| 107652 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1566259200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701993600000",
"number": "1558918052",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 W BAY STATE ST",
"address_2": "P.O. BOX 1104",
"city": "ALHAMBRA",
"state": "CA",
"postal_code": "91802",
"telephone_number": "626-656-3431"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "515 COLUMBIA AVE # 200",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900171209",
"telephone_number": "213-249-9388",
"fax_number": "213-389-7993"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OVERLY",
"first_name": "TRACY",
"middle_name": "RENE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-08-20",
"last_updated": "2023-12-08",
"certification_date": "2023-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "107652",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.