Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Jezreel Martin Supetran

Individual provider Clinical Social Worker · NPI 1629301213

Mr. Jezreel Martin Supetran is a Clinical Social Worker in Simi Valley, California. Qualified in 2010, 16 years ago. Practices as a sole proprietor. Licensed in California.

Years since qualifying
16
Licensed in
CA
In the registry since
2009
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Practice location Address checks out

1750 Heywood St Unit B
Simi Valley, CA 93065-6552
Phone: (805) 694-8368
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 61376 (CA)

Record details

NPI number1629301213
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedSeptember 14, 2009
Last updated in NPPESMarch 16, 2026
Certification dateMarch 16, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2010 (16 years in practice)
Accepts Medicare assignment Not indicated

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