Healthcare Provider Details

I. General information

NPI: 1669428157
Provider Name (Legal Business Name): RITA K. MCCREREY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RITA K. MCCREREY LCSW

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 03/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5575 LAKE PARK WAY STE 114
LA MESA CA
91942-1674
US

IV. Provider business mailing address

5575 LAKE PARK WAY STE 114
LA MESA CA
91942-1674
US

V. Phone/Fax

Practice location:
  • Phone: 619-922-6059
  • Fax: 619-463-8986
Mailing address:
  • Phone: 619-922-6059
  • Fax: 619-463-8986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS12880
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: