Healthcare Provider Details

I. General information

NPI: 1063809218
Provider Name (Legal Business Name): JESSICA NICOLE BARTON-GRIMLEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA NICOLE JOHNSON

II. Dates (important events)

Enumeration Date: 04/24/2015
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6446 INDIANA AVE
LONG BEACH CA
90805-2824
US

IV. Provider business mailing address

6446 INDIANA AVE
LONG BEACH CA
90805-2824
US

V. Phone/Fax

Practice location:
  • Phone: 562-480-1633
  • Fax:
Mailing address:
  • Phone: 213-204-6664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW111386
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: