Healthcare Provider Details

I. General information

NPI: 1689982811
Provider Name (Legal Business Name): ELENA DESPINA DASGUPTA-TSINIKAS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2010
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 WOODRUFF AVE STE 209
LONG BEACH CA
90808-2149
US

IV. Provider business mailing address

3840 WOODRUFF AVE STE 209
LONG BEACH CA
90808-2149
US

V. Phone/Fax

Practice location:
  • Phone: 562-372-6160
  • Fax: 562-330-2523
Mailing address:
  • Phone: 562-372-6160
  • Fax: 562-330-2523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW 33287
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW69299
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: