Active NPI
Benjamin Supkoff
- Clinical Social Worker
- Los Angeles, CA
National Provider Identifier
1720338619
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 765 Weyburn Ter
#102
Los Angeles, CA 90024-2843 - Phone
- (916) 743-1606
- NPI assigned
- Sep 18, 2012
- Sex
- Male
- Sole proprietor
- Yes
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 | Primary |
Addresses
Primary practice location
765 Weyburn Ter
#102
Los Angeles, CA 90024-2843
Mailing address
765 Weyburn Ter #102
Los Angeles, CA 90024-2843
Phone (916) 743-1606
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1347926400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1347926400000",
"number": "1720338619",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "765 WEYBURN TER #102",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900242843",
"telephone_number": "916-743-1606"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "765 WEYBURN TER",
"address_2": "#102",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900242843",
"telephone_number": "916-743-1606"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUPKOFF",
"first_name": "BENJAMIN",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-09-18",
"last_updated": "2012-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"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 Sep 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.