Healthcare Provider Details

I. General information

NPI: 1407193782
Provider Name (Legal Business Name): CINNAMON HARPER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 CHILDRENS WAY # MC5134
SAN DIEGO CA
92123-4223
US

IV. Provider business mailing address

3020 CHILDRENS WAY # MC6013
SAN DIEGO CA
92123-4223
US

V. Phone/Fax

Practice location:
  • Phone: 858-966-5990
  • Fax: 858-966-7508
Mailing address:
  • Phone: 858-576-1700
  • Fax: 858-966-5992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number34534
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number99113
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: