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General NPI Number Information
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NPI Number | 1831692573
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Entity Type | Organization
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Legal Business Name | THE PRACTICE COUNSELING SERVICES LICENSED CLINICAL SOCIAL WORKER, PC
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Dates
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Enumeration Date | 03/08/2018
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Last Update Date | 07/06/2018
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Provider Practice Location Address
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Address Line | 1000 TEXAS ST STE D
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City | FAIRFIELD
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State | CA
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Zip | 94533
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Country | US
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Telephone | 562-587-7409
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 TEXAS ST STE D
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City | FAIRFIELD
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State | CA
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Zip | 94533-5700
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Country | US
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Telephone | 562-587-7409
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MARA SAMMARTINO
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Credential | LCSW
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Telephone | 562-587-7409
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 71187
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 79256
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 69929
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 70176
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License Number State | CA
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