Healthcare Provider Details

I. General information

NPI: 1144533787
Provider Name (Legal Business Name): LYNDON R. OLMEDA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2010
Last Update Date: 03/11/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 W COMPTON BLVD
COMPTON CA
90220-3167
US

IV. Provider business mailing address

11550 E. MAIN STREET
SANTA MARIA CA
93454
US

V. Phone/Fax

Practice location:
  • Phone: 310-639-8601
  • Fax:
Mailing address:
  • Phone: 424-362-4848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRA856608
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 26449
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: