Active NPI
Jennifer Phoenix Dawn, LCSW
- Clinical Social Worker
- South Lake Tahoe, CA
National Provider Identifier
1760614366
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 26121
- Practice address
- 1900 Lake Tahoe Blvd
South Lake Tahoe, CA 96150-6305 - Phone
- (530) 573-7970
- NPI assigned
- Aug 14, 2009
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 26121 | CA | Primary |
Addresses
Primary practice location
1900 Lake Tahoe Blvd
South Lake Tahoe, CA 96150-6305
Mailing address
1900 Lake Tahoe Blvd
South Lake Tahoe, CA 96150-6305
Phone (530) 573-7970
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 |
|---|---|---|---|
| 26121 | CA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1250208000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1559260800000",
"number": "1760614366",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 LAKE TAHOE BLVD",
"city": "SOUTH LAKE TAHOE",
"state": "CA",
"postal_code": "961506305",
"telephone_number": "530-573-7970"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1900 LAKE TAHOE BLVD",
"city": "SOUTH LAKE TAHOE",
"state": "CA",
"postal_code": "961506305",
"telephone_number": "530-573-7970"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAWN",
"first_name": "JENNIFER",
"middle_name": "PHOENIX",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-08-14",
"last_updated": "2019-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "26121",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Lake Tahoe, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.