Active NPI
Jennifer Hines, LCSW
- Clinical Social Worker
- Venice, CA
National Provider Identifier
1861641466
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 26715
- Practice address
- 204 Hampton Dr
Venice, CA 90291-2623 - Phone
- (310) 396-6468
- NPI assigned
- Sep 18, 2008
- Last updated
- Mar 5, 2012
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149-013458 | IL | |
| Clinical Social Worker | 1041C0700X | 26715 | CA | Primary |
Addresses
Primary practice location
204 Hampton Dr
Venice, CA 90291-2623
Mailing address
204 Hampton Dr
Venice, CA 90291-2623
Phone (310) 396-6468
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 1, 2024 through Oct 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149-013458 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1221696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1330905600000",
"number": "1861641466",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "204 HAMPTON DR",
"city": "VENICE",
"state": "CA",
"postal_code": "902912623",
"telephone_number": "310-396-6468"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "204 HAMPTON DR",
"city": "VENICE",
"state": "CA",
"postal_code": "902912623",
"telephone_number": "310-396-6468"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HINES",
"first_name": "JENNIFER",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-09-18",
"last_updated": "2012-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149-013458",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "26715",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Venice, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.