Active NPI
Juan Jose Hernandez-Codallos
- Clinical Social Worker
- Laramie, WY
National Provider Identifier
1740613306
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 92529
- Practice address
- 615 Roger Canyon Rd
Laramie, WY 82072-8902 - Phone
- (209) 918-8761
- NPI assigned
- Aug 17, 2013
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | |||
| Case Manager/Care Coordinator | 171M00000X | |||
| Clinical Social Worker | 1041C0700X | 92529 | CA | Primary |
Addresses
Primary practice location
615 Roger Canyon Rd
Laramie, WY 82072-8902
Mailing address
PO Box 1733
Laramie, WY 82073-1733
Other practice location 1
1263 N 15th St
Laramie, WY 82072
Phone (307) 745-8915
Other practice location 2
1263 N 15th St
Laramie, WY 82072
Phone (307) 745-8915
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 |
|---|---|---|---|
| 92529 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1376697600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690761600000",
"number": "1740613306",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1733",
"city": "LARAMIE",
"state": "WY",
"postal_code": "820731733"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "615 ROGER CANYON RD",
"city": "LARAMIE",
"state": "WY",
"postal_code": "820728902",
"telephone_number": "209-918-8761"
}
],
"practiceLocations": [
{
"address_1": "1263 N 15th St",
"address_purpose": "LOCATION",
"city": "Laramie",
"state": "WY",
"postal_code": "82072",
"country_code": "US",
"telephone_number": "307-745-8915",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1263 N 15th St",
"address_purpose": "LOCATION",
"city": "Laramie",
"state": "WY",
"postal_code": "82072",
"country_code": "US",
"telephone_number": "307-745-8915",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HERNANDEZ-CODALLOS",
"first_name": "JUAN",
"middle_name": "JOSE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-08-17",
"last_updated": "2023-07-31",
"certification_date": "2023-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": null,
"license": null,
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "92529",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Laramie, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.