Active NPI
Marie Mizuno
- Clinical Social Worker
- Los Angeles, CA
National Provider Identifier
1639471832
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW70387
- Practice address
- 1233 S la Cienega Blvd
Los Angeles, CA 90035-2520 - Phone
- (310) 855-0031
- Fax
- (310) 855-0138
- NPI assigned
- Nov 22, 2010
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCSW70387 | CA | Primary |
| Social Worker | 104100000X | ASW33330 | CA |
Addresses
Primary practice location
1233 S la Cienega Blvd
Los Angeles, CA 90035-2520
Mailing address
1233 S la Cienega Blvd
Los Angeles, CA 90035-2520
Phone (310) 855-0031
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 |
|---|---|---|---|
| ASW33330 | CA | MD | Social Worker |
| LCSW70387 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1290384000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1474502400000",
"number": "1639471832",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1233 S LA CIENEGA BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900352520",
"telephone_number": "310-855-0031",
"fax_number": "310-855-0138"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1233 S LA CIENEGA BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900352520",
"telephone_number": "310-855-0031",
"fax_number": "310-855-0138"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIZUNO",
"first_name": "MARIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-11-22",
"last_updated": "2016-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCSW70387",
"primary": true
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "CA",
"license": "ASW33330",
"primary": false
}
],
"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 Sep 22, 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.