Healthcare Provider Details

I. General information

NPI: 1578238531
Provider Name (Legal Business Name): SERENITY OAK, LCSW, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1672 W AVENUE J STE 202
LANCASTER CA
93534-2861
US

IV. Provider business mailing address

1672 W AVENUE J STE 202
LANCASTER CA
93534-2861
US

V. Phone/Fax

Practice location:
  • Phone: 661-434-1104
  • Fax:
Mailing address:
  • Phone: 323-901-6303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. ROCIO VILLALOBOS
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 661-434-1104