=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609679265
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLAUDIA Q. BALISCAO, A LICENSED CLINICAL SOCIAL WORKER CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2025
-----------------------------------------------------
Last Update Date | 03/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 36396 WHITE RIDGE RD
-----------------------------------------------------
City | WINCHESTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92596-8691
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-848-4949
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 892174
-----------------------------------------------------
City | TEMECULA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92589-2174
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-848-4949
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. CLAUDIA QUINTERO BALISCAO
-----------------------------------------------------
Credential | LCSW, CSAC
-----------------------------------------------------
Telephone | 951-848-4949
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------