Myndloft Licensed Clinical Social Worker Professional Corporation

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

MYNDLOFT LICENSED CLINICAL SOCIAL WORKER PROFESSIONAL CORPORATION

Practice address

240 W Chapman Ave Ste 200
Orange, CA 92866-1316

Phone

(855) 750-5010

Fax

(619) 354-1803

NPI assigned

Mar 6, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Dale Elery Werner, PHD

Title

Administrator

Phone

(949) 569-9226

Specialties & licenses 3

Addresses

Other names 2

• mindloft Doing business as
• myndloft Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kelly Rauch, PHD, LMFT

  • Marriage & Family Therapist
  • Orange, CA
  • NPI 1336607688
  Medicare reassignment NPD
• Perla Barragan

  • Clinical Social Worker
  • Culver City, CA
  • NPI 1972267714
  NPD (past)
• Claudia Garcia, LCSW

  • Clinical Social Worker
  • Orange, CA
  • NPI 1790462588
  NPD (past)
• Patricia Rojas

  • Clinical Social Worker
  • Orange, CA
  • NPI 1962684100
  NPD (past)
• Stephany Agudelo

  • Clinical Social Worker
  • Poughkeepsie, NY
  • NPI 1467825331
  NPD (past)

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

{
    "created_epoch": "1678060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683072000000",
    "number": "1093415481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3340",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927813340",
            "telephone_number": "855-750-5010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 W CHAPMAN AVE STE 200",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928661316",
            "telephone_number": "855-750-5010",
            "fax_number": "619-354-1803"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "601 N Hampton St Apt 1424",
            "address_purpose": "LOCATION",
            "city": "Fort Worth",
            "state": "TX",
            "postal_code": "761025043",
            "country_code": "US",
            "telephone_number": "949-569-9173",
            "fax_number": "619-354-1803",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3162 Upas St",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921044246",
            "country_code": "US",
            "telephone_number": "949-569-9244",
            "fax_number": "619-354-1803",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MYNDLOFT LICENSED CLINICAL SOCIAL WORKER PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-06",
        "last_updated": "2023-05-03",
        "certification_date": "2023-05-03",
        "status": "A",
        "authorized_official_last_name": "WERNER",
        "authorized_official_first_name": "DALE",
        "authorized_official_middle_name": "ELERY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "949-569-9226",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "mindloft",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "myndloft",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Toby Myatt, MD
• Breanne Cisneros Myers, NP
• Darcy Leigh Myers
• Maddie Myers
• Kristene Myklak, M.D.
• Joon W Myung, NP
• MZ Ascent LLC
• Farnaz Nabavi Larijani, PA
• Neil Shayan Nabavi
• Alexia Sara Nabbout I

• Clinical Social Worker in Orange, CA
• Providers in Orange, 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 May 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.