=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053093955
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NEEL SAWHNEY ASW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2023
-----------------------------------------------------
Last Update Date | 08/01/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 995 GATEWAY CENTER WAY STE 106
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92102-4544
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 929-339-9613
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 712 OCEAN LN
-----------------------------------------------------
City | IMPERIAL BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91932-1818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 929-339-9613
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 116485
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------