Active NPI
Kristine M Douglas, LCSW, MPH
- Clinical Social Worker
- Los Angeles, CA
National Provider Identifier
1992447981
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 25423
- Practice address
- 1849 Sawtelle Blvd Ste 610
Los Angeles, CA 90025-7013 - Phone
- (323) 553-1194
- NPI assigned
- Apr 10, 2022
- Sex
- Female
- 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 | 25423 | CA | Primary |
Addresses
Primary practice location
1849 Sawtelle Blvd Ste 610
Los Angeles, CA 90025-7013
Mailing address
1849 Sawtelle Blvd Ste 610
Los Angeles, CA 90025-7013
Phone (323) 553-1194
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250313000388 | CA | Practitioner - Clinical Social Worker | 4486175957 | Practice locations: Pasadena, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25423 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1649548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649548800000",
"number": "1992447981",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1849 SAWTELLE BLVD STE 610",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900257013",
"telephone_number": "323-553-1194"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1849 SAWTELLE BLVD STE 610",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900257013",
"telephone_number": "323-553-1194"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUGLAS",
"first_name": "KRISTINE",
"middle_name": "M",
"name_prefix": "Ms.",
"credential": "LCSW, MPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-04-10",
"last_updated": "2022-04-10",
"certification_date": "2022-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "25423",
"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 Apr 10, 2022; 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.