Jessie Licon, ASW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

116305 Issued in CA

Practice address

2121 W Temple St
Los Angeles, CA 90026-4915

Phone

(323) 722-6205

NPI assigned

Aug 31, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1661904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707264000000",
    "number": "1578283404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 W TEMPLE ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900264915",
            "telephone_number": "213-385-5100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 W TEMPLE ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900264915",
            "telephone_number": "323-722-6205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICON",
        "first_name": "JESSIE",
        "credential": "ASW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-31",
        "last_updated": "2024-02-07",
        "certification_date": "2024-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "116305",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amos Lichtman
• Mary Liciaga
• Adrian Licon-Carrillo
• Alma Licon, R.N.
• Daisy Licon
• Nicole Mateo Licup Nam, NP
• Lida Esbati Mashayekhi
• Liddo Grannies Touch
• Liddy Health & Fitness Chiropractic Inc
• Craig Liebenson, D.C.

• Clinical Social Worker in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.