Healthcare Provider Details

I. General information

NPI: 1952775728
Provider Name (Legal Business Name): DAVID RECINOS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2015
Last Update Date: 04/19/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 TOWN CENTER DR STE 300
OXNARD CA
93036-1117
US

IV. Provider business mailing address

1000 TOWN CENTER DR STE 300
OXNARD CA
93036-1117
US

V. Phone/Fax

Practice location:
  • Phone: 805-774-0034
  • Fax:
Mailing address:
  • Phone: 805-774-0034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMF67238
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW67238
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW67238
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number95624
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: