NPIMap

Individual provider Active NPI

Jacquelyn Valles

  • Clinical Social Worker
  • Van Nuys, CA
National Provider Identifier
1912336827
Registry record updated Oct 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW93889 Issued in CA
Practice address
6305 Woodman Ave
Van Nuys, CA 91401-2346
Phone
(818) 908-4999
NPI assigned
Nov 1, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Clinical Social Worker 1041C0700X LCSW93889 CA Primary

Addresses

Primary practice location

6305 Woodman Ave
Van Nuys, CA 91401-2346

Mailing address

6305 Woodman Ave
Van Nuys, CA 91401-2346
Phone (818) 908-4999

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220119000526 CA Practitioner - Clinical Social Worker 3375935687 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Community Memorial Health SystemGroup PAC ID 9537155676, 187 clinicians

Practice addresses (Care Compare)

120 N Ashwood Ave
Ventura, CA 93003-1810
Phone (805) 658-5800

4080 Loma Vista Rd
Suite F
Ventura, CA 93003-1811
Phone (805) 667-2841

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCSW93889CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Community Memorial Health System Current Accepting new patients
Community Memorial Health System CurrentSince Jan 1, 2022 Accepting new patients
Community Memorial Health System CurrentSince Jan 1, 2022 Accepting new patients
Community Physicians of Ventura County CurrentSince Mar 1, 2024 Accepting new patients
Community Physicians of Ventura County CurrentSince Mar 1, 2024 Accepting new patients
Community Physicians of Ventura County Past Accepting new patients

Locations

422 Arneill Rd
Ste B
Camarillo, CA 93010
Phone (805) 383-4510

1306 Maricopa Hwy
Ojai, CA 93023
Phone (805) 640-2260

2921 Saviers Rd
Oxnard, CA 93033
Phone (805) 487-5588

120 N Ashwood Ave
Ventura, CA 93003
Phone (805) 658-5800

5855 Olivas Park Dr
Ventura, CA 93003
Phone (805) 652-5469

138 W Main St
Ste E
Ventura, CA 93001
Phone (805) 667-2850

4080 Loma Vista Rd
Ste F
Ventura, CA 93003
Phone (805) 642-2574

147 N Brent St
Ventura, CA 93003
Phone (805) 652-5011

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 6

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.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1383264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698364800000",
    "number": "1912336827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6305 WOODMAN AVE",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914012346",
            "telephone_number": "818-908-4999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6305 WOODMAN AVE",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914012346",
            "telephone_number": "818-908-4999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VALLES",
        "first_name": "JACQUELYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-01",
        "last_updated": "2023-10-27",
        "certification_date": "2023-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW93889",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Van Nuys, CA

Sources for this page

Verify at the official NPI Registry.