Healthcare Provider Details

I. General information

NPI: 1437259256
Provider Name (Legal Business Name): DAVI ELLEN GENDEL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 LUPINE WAY
OCEANSIDE CA
92057-8551
US

IV. Provider business mailing address

3142 VISTA WAY STE 205
OCEANSIDE CA
92056-3628
US

V. Phone/Fax

Practice location:
  • Phone: 858-753-9281
  • Fax:
Mailing address:
  • Phone: 760-758-1480
  • Fax: 760-435-9472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 22913
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: