Healthcare Provider Details

I. General information

NPI: 1235756164
Provider Name (Legal Business Name): MITCHELL GREENWALD ASW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47825 OASIS ST
INDIO CA
92201-6950
US

IV. Provider business mailing address

47665 OASIS ST
INDIO CA
92201-6950
US

V. Phone/Fax

Practice location:
  • Phone: 760-863-8455
  • Fax: 760-863-8587
Mailing address:
  • Phone: 760-863-7384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number122994
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: