Phillip George Tardanico, LCSW 69611

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW69611 Issued in CA

Practice address

15000 Seventh St Ste 209
Victorville, CA 92395-3853

Phone

(760) 217-9527

Fax

(442) 267-5623

NPI assigned

Feb 16, 2016

Last updated

Jun 4, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Mr. Phillip Tardanico Professional name

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2002

Medicare assignment

May accept Medicare assignment

Group practices

Phillip Tardanico, Licensed Clinical Social Worker and Associates, PCGroup PAC ID 2860913597, 2 clinicians

Sud Specialty Group - CaGroup PAC ID 9537534177, 519 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Phillip Tardanico, Licensed Clinical Social Worker & Associates, PC

  • Clinical Social Worker
  • Victorville, CA
  • NPI 1063020717

  Addiction (Substance Use Disorder)

  Medicare reassignment Care Compare group NPD Authorized official
• Sud Specialty Group - Ca

  dba Rula Health

  • Addiction Medicine (Psychiatry & Neurology) Physician
  • Santa Clara, CA
  • NPI 1972138238

  Addiction (Substance Use Disorder)

  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1455580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717459200000",
    "number": "1063871291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15000 SEVENTH ST STE 209",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923953853",
            "telephone_number": "760-217-9527",
            "fax_number": "442-267-5623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15000 SEVENTH ST STE 209",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923953853",
            "telephone_number": "760-217-9527",
            "fax_number": "442-267-5623"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1738 N Waterman Ave Ste 3",
            "address_purpose": "LOCATION",
            "city": "San Bernardino",
            "state": "CA",
            "postal_code": "924045131",
            "country_code": "US",
            "telephone_number": "760-217-9527",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "15000 Seventh St Ste 203",
            "address_purpose": "LOCATION",
            "city": "Victorville",
            "state": "CA",
            "postal_code": "923953851",
            "country_code": "US",
            "telephone_number": "760-217-9527",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TARDANICO",
        "first_name": "PHILLIP",
        "middle_name": "GEORGE",
        "name_prefix": "Mr.",
        "credential": "LCSW 69611",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-02-16",
        "last_updated": "2024-06-04",
        "certification_date": "2024-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "A01210315",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW69611",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "800682649",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PHILLIP",
            "last_name": "TARDANICO",
            "prefix": "MR.",
            "credential": "LCSW, MAC, & SAP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Gladys C Taningco, MD
• Pooja Tanjavour, M.D.
• George Elias Tannouz, PHARMD
• Briana Tapia
• Rosa Tapia
• Amanda Marie Tarwater
• Julia Tashima, A.T.,C
• Terri Ramona Tauqir, PSYD
• Eleazar Somintac Tayag, PT
• Erdemar Tayag, PT

• Clinical Social Worker in Victorville, CA
• Providers in Victorville, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.