Active NPI
Dominique Perez
- Clinical Social Worker
- Los Angeles, CA
National Provider Identifier
1679966816
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW106626
- Practice address
- 333 S Beaudry Ave
Los Angeles, CA 90017-1466 - Phone
- (213) 241-3841
- NPI assigned
- Mar 12, 2015
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Clinical Social Worker | 1041C0700X | ASW72055 | CA | |
| Clinical Social Worker | 1041C0700X | LCSW106626 | CA | Primary |
Addresses
Primary practice location
333 S Beaudry Ave
Los Angeles, CA 90017-1466
Mailing address
333 S Beaudry Ave
Los Angeles, CA 90017-1466
Phone (213) 241-3841
Other practice location 1
1501 Hughes Way
Suite 150
Long Beach, CA 90810-1876
Phone (310) 221-6336
Other practice location 2
1501 Hughes Way
Suite 150
Long Beach, CA 90810
Phone (310) 221-6336
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 |
|---|---|---|---|
| ASW72055 | CA | MD | Clinical Social Worker |
| LCSW106626 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1426118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654560000000",
"number": "1679966816",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "333 S BEAUDRY AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900171466",
"telephone_number": "213-241-3841",
"fax_number": "213-241-3305"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "333 S BEAUDRY AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900171466",
"telephone_number": "213-241-3841"
}
],
"practiceLocations": [
{
"address_1": "1501 Hughes Way",
"address_2": "Suite 150",
"address_purpose": "LOCATION",
"city": "Long Beach",
"state": "CA",
"postal_code": "908101876",
"country_code": "US",
"telephone_number": "310-221-6336",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1501 Hughes Way",
"address_2": "Suite 150",
"address_purpose": "LOCATION",
"city": "Long Beach",
"state": "CA",
"postal_code": "90810",
"country_code": "US",
"telephone_number": "310-221-6336",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PEREZ",
"first_name": "DOMINIQUE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-03-12",
"last_updated": "2022-06-07",
"certification_date": "2022-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "ASW72055",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCSW106626",
"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 Jun 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.