MEDICARE: NICOLE JASMINE WATSON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	59620	CA

General Provider Information

NPI Number	:	1366783375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE JASMINE WATSON LCSW

Provider Business Mailing Address
First Line	:	510 S VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-1912
Country	:	US
Telephone Number	:	310-524-2236
Fax Number	:

Provider Business Practice Location Address
First Line	:	510 S VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-1912
Country	:	US
Telephone Number	:	310-524-2236
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2013
Last Update Date	:	03/02/2026

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