Individual provider Active NPI

Nicole Wright

  • Clinical Social Worker
  • Gardena, CA
National Provider Identifier
1811123698
Registry record updated Jul 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
121100 Issued in CA
Practice address
879 W 190TH St Ste 300
Gardena, CA 90248-4223
Phone
(310) 850-0115
NPI assigned
Jun 7, 2009
Last updated
Jul 10, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2024

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 112706 CA
Mental Health Counselor 101YM0800X ASW75318 CA
Clinical Social Worker 1041C0700X 112706 CA
Student in an Organized Health Care Education/Training Program 390200000X
Clinical Social Worker 1041C0700X 121100 CA Primary

Addresses

Primary practice location

879 W 190TH St Ste 300
Gardena, CA 90248-4223

Mailing address

879 W 190TH St Ste 300
Gardena, CA 90248-4223
Phone (310) 850-0115

Other practice location 1

2121 W Temple St
Los Angeles, CA 90026-4915
Phone (310) 850-0115

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
I20241108002957 CA Practitioner - Clinical Social Worker 6800320110 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ASW75318CAMDMental Health Counselor
112706CAMDClinical Social Worker
121100CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Special Service for Groups, Inc. Current Accepting new patients
Special Service for Groups, Inc. CurrentSince Sep 1, 2024 Accepting new patients

Locations

905 E 8th St
Los Angeles, CA 90021
Phone (213) 553-1800

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": "1244332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720569600000",
    "number": "1811123698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "879 W 190TH ST STE 300",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902484223",
            "telephone_number": "310-850-0115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "879 W 190TH ST STE 300",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902484223",
            "telephone_number": "310-850-0115"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2121 W Temple St",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900264915",
            "country_code": "US",
            "telephone_number": "310-850-0115",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WRIGHT",
        "first_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-07",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "112706",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "ASW75318",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "112706",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "121100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gardena, CA

Sources for this page

Verify at the official NPI Registry.