Individual provider · Type 1 NPI

Jimesha Wagoner

Clinical Social Worker · Los Angeles, CA

NPI number 1023837333 Active

Practice location

840 N Avenue 66
Los Angeles, CA 90042-1508

Specialties and licenses

TaxonomyCodeLicense
Social Worker 104100000XNone listed
Social Worker 104100000X131874 (CA)
Clinical Social Worker Primary 1041C0700X131874 (CA)

Clinical Social Worker: A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpers…

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About NPI 1023837333

Jimesha Wagoner's National Provider Identifier is 1023837333, issued on Oct 4, 2024. The primary taxonomy on file is Clinical Social Worker (1041C0700X), and the practice location is in Los Angeles, CA. The record was last updated on Oct 16, 2026.