Healthcare Provider Details

I. General information

NPI: 1669307211
Provider Name (Legal Business Name): S & S LICENSED CLINICAL SOCIAL WOKER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4193 FLAT ROCK DR STE 200-410
RIVERSIDE CA
92505-7111
US

IV. Provider business mailing address

4193 FLAT ROCK DR STE 200-410
RIVERSIDE CA
92505-7111
US

V. Phone/Fax

Practice location:
  • Phone: 951-227-0580
  • Fax:
Mailing address:
  • Phone: 951-227-0580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SAMI ELQUZA
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: LCSW
Phone: 951-227-0580