Healthcare Provider Details

I. General information

NPI: 1497300693
Provider Name (Legal Business Name): REPRODUCTIVE MENTAL HEALTH AND WELLNESS LICENSED CLINICAL SOCIAL WORKE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11440 W BERNARDO CT STE 300
SAN DIEGO CA
92127-1644
US

IV. Provider business mailing address

11440 W BERNARDO CT STE 300
SAN DIEGO CA
92127-1644
US

V. Phone/Fax

Practice location:
  • Phone: 858-380-2600
  • Fax: 858-367-6160
Mailing address:
  • Phone: 858-380-2600
  • Fax: 858-367-6160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: EMILY REMBA
Title or Position: PRESIDENT
Credential: LCSW
Phone: 858-367-3622