Individual provider Active NPI

Jennifer Secrease, LCSW

  • Clinical Social Worker
  • San Luis Obispo, CA
National Provider Identifier
1831923903
Registry record updated Aug 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW121994 Issued in CA
Practice address
40 Prado Rd
San Luis Obispo, CA 93401-7313
Phone
(805) 473-4712
Fax
(805) 473-1830
NPI assigned
Aug 29, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LCSW121994 CA Primary

Addresses

Primary practice location

40 Prado Rd
San Luis Obispo, CA 93401-7313

Mailing address

2050 S Blosser Rd
Santa Maria, CA 93458-7310
Phone (805) 361-8017

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
I20240912002785 CA Practitioner - Clinical Social Worker 8921548256 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Health Centers of the Central Coast IncGroup PAC ID 7416868120, 74 clinicians

Practice addresses (Care Compare)

1551 Bishop St
Suite 240
San Luis Obispo, CA 93401-4661
Phone (805) 434-1038

1551 Bishop St
Suite A160
San Luis Obispo, CA 93401-4636
Phone (805) 781-4230

2801 Santa Maria Way
Santa Maria, CA 93455-2118

4723 W Main St
Suite H
Guadalupe, CA 93434-1787
Phone (805) 343-5577

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCSW121994CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Centers of the Central Coast Inc CurrentSince Jul 19, 2024 Accepting new patients
Community Health Centers of the Central Coast Inc Current Accepting new patients
Community Health Centers of the Central Coast Inc Current Accepting new patients
Community Health Centers of the Central Coast Inc CurrentSince Jul 19, 2024 Accepting new patients
Community Health Centers of the Central Coast Inc Current Accepting new patients

Locations

150 Tejas Pl
Nipomo, CA 93444
Phone (805) 929-3254

40 Prado Rd
San Luis Obispo, CA 93401
Phone (661) 205-9755

2050 S Blosser Rd
Santa Maria, CA 93458
Phone (805) 361-8014

1551 Bishop St
Ste A160
Sn Luis Obisp, CA 93401
Phone (805) 781-4230

325 Posada Ln
Templeton, CA 93465
Phone (805) 239-0644

Interoperability endpoints

  • Direct secure messaging: jennifer.secrease.1@17363.direct.athenahealth.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": "1724889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724889600000",
    "number": "1831923903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 S BLOSSER RD",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934587310",
            "telephone_number": "805-361-8017",
            "fax_number": "805-361-8097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 PRADO RD",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934017313",
            "telephone_number": "805-473-4712",
            "fax_number": "805-473-1830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SECREASE",
        "first_name": "JENNIFER",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-29",
        "last_updated": "2024-08-29",
        "certification_date": "2024-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW121994",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Luis Obispo, CA

Sources for this page

Verify at the official NPI Registry.