Adrian Reveles, LCSW #112718

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

112718 Issued in CA

Practice address

505 S Pacific Ave Ste 101
San Pedro, CA 90731-2656

Phone

(310) 774-0875

NPI assigned

Mar 11, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• San Fernando Recovery Center

  • Substance Abuse Rehabilitation Facility
  • San Fernando, CA
  • NPI 1164980603
  NPD (past)
• San Fernando Recovery Center

  • Substance Use Disorder Rehabilitation Clinic/Center
  • San Fernando, CA
  • NPI 1275478745
  NPD (past)

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

{
    "created_epoch": "1552262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720051200000",
    "number": "1891253613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7554 WELLMAN ST",
            "city": "COMMERCE",
            "state": "CA",
            "postal_code": "900403314",
            "telephone_number": "323-868-1281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 S PACIFIC AVE STE 101",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907312656",
            "telephone_number": "310-774-0875"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "762 Griswold Ave",
            "address_purpose": "LOCATION",
            "city": "San Fernando",
            "state": "CA",
            "postal_code": "913402105",
            "country_code": "US",
            "telephone_number": "747-500-9405",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REVELES",
        "first_name": "ADRIAN",
        "credential": "LCSW #112718",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-11",
        "last_updated": "2024-07-04",
        "certification_date": "2024-07-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "112718",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gina Remington, R.N.
• Neil D Remington, M.D.
• Renew Integrated Program-2 Incorporation
• Restoring Accountability
• Retina Institute of California Medical Group, a California Medical Par
• Monica Reynoso
• Caroline June Rhee, PHARMD, RPH
• Riamd, Incorporation
• Alex Habib Riazati, PSYCHOLOGY TRAINEE
• Richard C. Smith, M.D. a Professional Corporation

• Clinical Social Worker in San Pedro, CA
• Providers in San Pedro, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.