Healthcare Provider Details

I. General information

NPI: 1063347565
Provider Name (Legal Business Name): MARY NAIMIE LCSW, 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

1238 PUERTA DEL SOL
SAN CLEMENTE CA
92673-6310
US

IV. Provider business mailing address

1238 PUERTA DEL SOL
SAN CLEMENTE CA
92673-6310
US

V. Phone/Fax

Practice location:
  • Phone: 949-234-1120
  • Fax:
Mailing address:
  • Phone: 949-234-1120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MARY A NAIMIE
Title or Position: PRESIDENT
Credential: LCSW
Phone: 949-234-1120