Healthcare Provider Details

I. General information

NPI: 1548040330
Provider Name (Legal Business Name): LEAH VERGEL DE DIOS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2023
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2659 STATE ST STE 100
CARLSBAD CA
92008-1627
US

IV. Provider business mailing address

PO BOX 3413
NEWPORT BEACH CA
92659-8413
US

V. Phone/Fax

Practice location:
  • Phone: 866-938-3831
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number138937
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: