Active NPI
Pamela Suzanne Gengo, LCSW
- Clinical Social Worker
- Banning, CA
National Provider Identifier
1083710594
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 11303
- Practice address
- 1330 W Ramsey St Ste 100
Banning Mental Health Clinic
Banning, CA 92220-4448 - Phone
- (951) 849-7142
- NPI assigned
- Sep 15, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 11303 | CA | Primary |
Addresses
Primary practice location
1330 W Ramsey St Ste 100
Banning Mental Health Clinic
Banning, CA 92220-4448
Mailing address
Banning Mental Health Clinic
P.O. Box 1148
Banning, CA 92220-4448
Phone (951) 849-7142
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11303 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158278400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184544000000",
"number": "1083710594",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "BANNING MENTAL HEALTH CLINIC",
"address_2": "P.O. BOX 1148",
"city": "BANNING",
"state": "CA",
"postal_code": "922204448",
"telephone_number": "951-849-7142"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1330 W RAMSEY ST STE 100",
"address_2": "BANNING MENTAL HEALTH CLINIC",
"city": "BANNING",
"state": "CA",
"postal_code": "922204448",
"telephone_number": "951-849-7142"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GENGO",
"first_name": "PAMELA",
"middle_name": "SUZANNE",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-15",
"last_updated": "2007-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "11303",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Banning, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.