MEDICARE: ELENA DESPINA DASGUPTA-TSINIKAS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker	ASW 33287	CA
3	1041C0700X	Clinical Social Worker	LCSW69299	CA

General Provider Information

NPI Number	:	1689982811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELENA DESPINA DASGUPTA-TSINIKAS LCSW

Provider Business Mailing Address
First Line	:	3840 WOODRUFF AVE STE 209
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-2149
Country	:	US
Telephone Number	:	562-372-6160
Fax Number	:	562-330-2523

Provider Business Practice Location Address
First Line	:	3840 WOODRUFF AVE STE 209
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-2149
Country	:	US
Telephone Number	:	562-372-6160
Fax Number	:	562-330-2523

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2010
Last Update Date	:	08/12/2022

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