Individual provider Active NPI

Roger Earl Quinney, LCSW

  • Clinical Social Worker
  • Los Angeles, CA
National Provider Identifier
1740203280
Registry record updated Apr 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SW16707 Issued in CA
Practice address
4602 Crenshaw Blvd
Suite 2C
Los Angeles, CA 90043-1219
Phone
(323) 296-1385
NPI assigned
Jul 25, 2006
Last updated
Apr 3, 2013By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 3, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X LCS 16707 CA
Clinical Social Worker 1041C0700X SW16707 CA Primary

Addresses

Primary practice location

4602 Crenshaw Blvd
Suite 2C
Los Angeles, CA 90043-1219

Mailing address

4827 11TH Ave
Los Angeles, CA 90043-4833
Phone (323) 292-0801

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050415000820 CA Practitioner - Clinical Social Worker 4981641305 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sud Specialty Group - CaGroup PAC ID 9537534177, 519 clinicians

Practice addresses (Care Compare)

4633 Old Ironsides Dr
Suite 304
Santa Clara, CA 95054-1846
Phone (866) 280-0260

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCS 16707CAMDMental Health Counselor
SW16707CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Quinneyassociates Inc Current Accepting new patients
Sud Specialty Group - Ca Clinical CurrentSince Aug 1, 2025 Accepting new patients

Locations

4602 Crenshaw Blvd
#2C
Los Angeles, CA 90043
Phone (323) 296-1385

4633 Old Ironsides Dr
Ste 304
Santa Clara, CA 95054
Phone (323) 745-8323

5201 Great America Pkwy
Ste 320
Santa Clara, CA 95054
Phone (323) 968-6182

520 Broadway
Ste 200
Santa Monica, CA 90401
Phone (949) 280-5295

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1364947200000",
    "number": "1740203280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4827 11TH AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900434833",
            "telephone_number": "323-292-0801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4602 CRENSHAW BLVD",
            "address_2": "SUITE 2C",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900431219",
            "telephone_number": "323-296-1385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUINNEY",
        "first_name": "ROGER",
        "middle_name": "EARL",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2013-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "LCS 16707",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "SW16707",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.