Healthcare Provider Details

I. General information

NPI: 1700702545
Provider Name (Legal Business Name): DANIELLE LOGUIDICE LICENSED CLINICAL SOCIAL WORKER PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 1ST AVE # 491
SAN DIEGO CA
92101-6976
US

IV. Provider business mailing address

630 1ST AVE # 491
SAN DIEGO CA
92101-6976
US

V. Phone/Fax

Practice location:
  • Phone: 619-742-7481
  • Fax: 858-742-3396
Mailing address:
  • Phone: 619-742-7481
  • Fax: 858-742-3396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DANIELLE LOGUIDICE
Title or Position: PROVIDER/OWNER
Credential: LCSW
Phone: 619-742-7481