Individual provider Active NPI

Julia Susan Smith

  • Clinical Social Worker
  • Los Angeles, CA
National Provider Identifier
1770142457
Registry record updated Nov 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
106946 Issued in CA
Practice address
522 S San Pedro St
Los Angeles, CA 90013-2102
Phone
(562) 867-7999
NPI assigned
Jun 6, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 12, 2024

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 89662 CA
Clinical Social Worker 1041C0700X 106946 CA Primary

Addresses

Primary practice location

522 S San Pedro St
Los Angeles, CA 90013-2102

Mailing address

522 S San Pedro St
Los Angeles, CA 90013-2102

Other identifiers 1

IdentifierTypeStateIssuer
171M00000XMedicaidCA

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
I20240114000113 CA Practitioner - Clinical Social Worker 5395197420 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
89662CAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
JWCH Institute Inc CurrentSince Nov 12, 2024 Accepting new patients
JWCH Institute, Inc. CurrentSince Nov 12, 2024 Accepting new patients
JWCH Institute Inc Case Manager/Care Coordinator Current Accepting new patients
Southern California Health & Rehabilitation Program Past Accepting new patients

Locations

5650 Jillson St
Commerce, CA 90040
Phone (213) 484-1186

522 S San Pedro St
Los Angeles, CA 90013
Phone (213) 486-4085

12360 Firestone Blvd
Norwalk, CA 90650
Phone (562) 281-0305

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: damaris.guardadonppsy.d1.p1@direct.jwch.nextgenshare.com

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1559779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731369600000",
    "number": "1770142457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "522 S SAN PEDRO ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900132102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "522 S SAN PEDRO ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900132102",
            "telephone_number": "562-867-7999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JULIA",
        "middle_name": "SUSAN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-06-06",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "89662",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "106946",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "171M00000X",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.