MEDICARE: ETERNAL OPTIMIST LICENSED CLINICAL SOCIAL WORKER, INC

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

General Provider Information

NPI Number	:	1992652291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ETERNAL OPTIMIST LICENSED CLINICAL SOCIAL WORKER, INC

Provider Business Mailing Address
First Line	:	521 S HORNE ST
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-4250
Country	:	US
Telephone Number	:	714-501-7563
Fax Number	:

Provider Business Practice Location Address
First Line	:	521 S HORNE ST
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-4250
Country	:	US
Telephone Number	:	714-501-7563
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ERICA MCDANIEL
Credential	:	LCSW
Telephone Number	:	714-501-7563

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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