Jane Davis Lisenced Clinical Social Worker Professional Psychotherapy

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

JANE DAVIS LISENCED CLINICAL SOCIAL WORKER PROFESSIONAL PSYCHOTHERAPY

Practice address

732 W 9TH St
San Pedro, CA 90731-3634

Phone

(213) 915-4024

NPI assigned

Oct 14, 2021

Organization subpart

No

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

Authorized official

Name

Ms. Jane Christine Graham Davis, LCSW

Title

President

Phone

(213) 915-4024

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1634169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634169600000",
    "number": "1679236947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1732 AVIATION BLVD # 122",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902782810",
            "telephone_number": "213-915-4024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "732 W 9TH ST",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907313634",
            "telephone_number": "213-915-4024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JANE DAVIS LISENCED CLINICAL SOCIAL WORKER PROFESSIONAL PSYCHOTHERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-14",
        "last_updated": "2021-10-14",
        "certification_date": "2021-10-13",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "JANE",
        "authorized_official_middle_name": "CHRISTINE GRAHAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "213-915-4024",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://simplepractice.com",
            "affiliation": "N",
            "endpointDescription": "Telehealth Platform",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Simple Practice Telehealth Platform",
            "address_1": "732 W 9th St",
            "city": "San Pedro",
            "state": "CA",
            "country_code": "US",
            "postal_code": "907313634",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Jennifer Randolph Acupuncture

• Mental Health Clinic/Center (Including Community Mental Health Center) in San Pedro, CA
• Providers in San Pedro, CA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2021; 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.