Individual provider · Type 1 NPI

Jessie Licon, ASW

Clinical Social Worker · Los Angeles, CA

NPI number 1578283404 Active

Practice location

2121 W Temple St
Los Angeles, CA 90026-4915

Specialties and licenses

Taxonomy	Code	License
Student in an Organized Health Care Education/Training Program	390200000X	None listed
Clinical Social Worker Primary	1041C0700X	139471 (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 1578283404

Jessie Licon, ASW's National Provider Identifier is 1578283404, issued on Aug 31, 2022. 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 22, 2026.