Active NPI
Jessica Marie Obana, LCSW
- Clinical Social Worker
- San Diego, CA
National Provider Identifier
1861684417
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 078435
- Practice address
- 3350 La Jolla Village Dr
San Diego, CA 92161-1329 - Phone
- (858) 552-8585
- Fax
- (858) 626-8570
- NPI assigned
- Aug 16, 2007
- 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 | 81354 | CA | |
| Clinical Social Worker | 1041C0700X | 078435 | NY | Primary |
Addresses
Primary practice location
3350 La Jolla Village Dr
San Diego, CA 92161-1329
Mailing address
6479 Seascape Dr
San Diego, CA 92139-2325
Phone (917) 495-5457
Other practice location 1
6479 Seascape Dr
San Diego, CA 92139-2325
Phone (917) 495-5457
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 078435 | Other | NY | NEW YORK LCSW |
| 81354 | Other | CA | CALIFORNIA LCSW |
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 |
|---|---|---|---|
| 81354 | CA | MD | Clinical Social Worker |
| 078435 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187222400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578268800000",
"number": "1861684417",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6479 SEASCAPE DR",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921392325",
"telephone_number": "917-495-5457"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3350 LA JOLLA VILLAGE DR",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921611329",
"telephone_number": "858-552-8585",
"fax_number": "858-626-8570"
}
],
"practiceLocations": [
{
"address_1": "6479 Seascape Dr",
"address_purpose": "LOCATION",
"city": "San Diego",
"state": "CA",
"postal_code": "921392325",
"country_code": "US",
"telephone_number": "917-495-5457",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "OBANA",
"first_name": "JESSICA",
"middle_name": "MARIE",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-08-16",
"last_updated": "2020-01-06",
"certification_date": "2020-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "81354",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "078435",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEW YORK LCSW",
"identifier": "078435",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CALIFORNIA LCSW",
"identifier": "81354",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.