Individual provider Active NPI

Stephanie Hernandez Enciso, LCSW

  • Clinical Social Worker
  • Pomona, CA
National Provider Identifier
1093294753
Registry record updated Sep 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
123318 Issued in CA
Practice address
1900 Royalty Dr Ste 180
Pomona, CA 91767-3046
Phone
(909) 766-7340
NPI assigned
Aug 13, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 17, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 123318 CA Primary

Addresses

Primary practice location

1900 Royalty Dr Ste 180
Pomona, CA 91767-3046

Mailing address

1900 Royalty Dr Ste 180
Pomona, CA 91767-3046
Phone (909) 766-7340

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20241224000961 CA Practitioner - Clinical Social Worker 6002343480 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Todos Para la SaludGroup PAC ID 1951673748, shared by 2 NPIs, 9 clinicians

Practice addresses (Care Compare)

3830 N 1St St
Fresno, CA 93726-2328

4420 N 1St St
Suite 123
Fresno, CA 93726-2328
Phone (559) 231-5366

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Tri-City Mental Health Authority CurrentSince Oct 18, 2024 Accepting new patients
Tri-City Mental Health Center PastSince Oct 18, 2024 Accepting new patients

Locations

2008 N Garey Ave
Pomona, CA 91767
Phone (909) 242-7640

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EBICCD/Endpoint/EBICCD

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1534118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726531200000",
    "number": "1093294753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 ROYALTY DR STE 180",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917673046",
            "telephone_number": "909-766-7340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 ROYALTY DR STE 180",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917673046",
            "telephone_number": "909-766-7340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENCISO",
        "first_name": "STEPHANIE",
        "middle_name": "HERNANDEZ",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-13",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "123318",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pomona, CA

Sources for this page

Verify at the official NPI Registry.