Jeremy Lee Mace, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW74014 Issued in CA

Practice address

475-750 Rice Canyon Road
Susanville, CA 96127

Phone

(530) 251-5100

NPI assigned

Oct 15, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Corrections and Rehabilitation-Headquarters

  • Pharmacy
  • Susanville, CA
  • NPI 1013543578
  NPD (past)

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

{
    "created_epoch": "1381795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693440000000",
    "number": "1750719480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5700 DOWDELL AVE UNIT 143",
            "city": "ROHNERT PARK",
            "state": "CA",
            "postal_code": "949284124",
            "telephone_number": "262-290-6529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475-750 RICE CANYON ROAD",
            "city": "SUSANVILLE",
            "state": "CA",
            "postal_code": "96127",
            "telephone_number": "530-251-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACE",
        "first_name": "JEREMY",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-10-15",
        "last_updated": "2023-08-31",
        "certification_date": "2023-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "129074-121",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW74014",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3411849631",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ian Blazer Lloyd
• Louise Loe
• Joseph Loring, MD
• Kirk E Lott, CRNA
• Megan Lee Luna, DH
• Camille Magarrell
• Catherina Maguire
• Kathleen Mahnke
• Richard Marason, O.D.
• Janet Marinoni

• Clinical Social Worker in Susanville, CA
• Providers in Susanville, CA by specialty
• Clinical Social Worker in California

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

Verify at the official NPI Registry.