Active NPI
SE Lee
- Clinical Social Worker
- Los Angeles, CA
National Provider Identifier
1922215763
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW59707
- Practice address
- 12099 W Washington Blvd
Los Angeles, CA 90066-5882 - Phone
- (310) 751-1171
- Fax
- (310) 313-7652
- NPI assigned
- May 17, 2007
- Last updated
- Sep 25, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCSW59707 | CA | Primary |
Addresses
Primary practice location
12099 W Washington Blvd
Los Angeles, CA 90066-5882
Mailing address
12099 W Washington Blvd
Los Angeles, CA 90066-5882
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200508001920 | CA | Practitioner - Clinical Social Worker | 5193156099 | Practice locations: Torrance, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW59707 | CA | MD | Clinical Social Worker |
| 59707 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727222400000",
"number": "1922215763",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12099 W WASHINGTON BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900665882"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12099 W WASHINGTON BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900665882",
"telephone_number": "310-751-1171",
"fax_number": "310-313-7652"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "SE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-17",
"last_updated": "2024-09-25",
"certification_date": "2024-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCSW59707",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.