Healthcare Provider Details

I. General information

NPI: 1104350792
Provider Name (Legal Business Name): JOSHUA SIMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2017
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 S LEMON AVE STE 9892
WALNUT CA
91789-2706
US

IV. Provider business mailing address

PO BOX 14824
LONG BEACH CA
90853-4824
US

V. Phone/Fax

Practice location:
  • Phone: 415-403-2156
  • Fax:
Mailing address:
  • Phone: 909-241-1746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW97971
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW118202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: