Individual provider Active NPI

Tiffany Granja

  • Clinical Social Worker
  • Covina, CA
National Provider Identifier
1093898694
Registry record updated Nov 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
26769 Issued in CA
Practice address
1359 N Grand Ave
Covina, CA 91724-1016
Phone
(626) 430-2875
Fax
(626) 331-0035
NPI assigned
Oct 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X ASW 17190 CA
Clinical Social Worker 1041C0700X 26769 CA Primary

Addresses

Primary practice location

1359 N Grand Ave
Covina, CA 91724-1016

Mailing address

1359 N Grand Ave
Covina, CA 91724-1016
Phone (626) 430-2875

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
I20140805000989 CA Practitioner - Clinical Social Worker 5890912471 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ASW 17190CAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Los Angeles County Department of Mental Health CurrentSince May 9, 2014 Accepting new patients
Los Angeles County Department of Mental Health CurrentSince May 9, 2014 Accepting new patients
Los Angeles County Department of Mental Health Current Accepting new patients

Locations

1359 N Grand Ave
Covina, CA 91724
Phone (626) 430-2900

14112 S Kingsley Dr
Gardena, CA 90249
Phone (310) 217-7312

510 S Vermont Ave
Fl 19
Los Angeles, CA 90020
Phone (213) 480-3416

Organizations & group practices 3

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": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605571200000",
    "number": "1093898694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1359 N GRAND AVE",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917241016",
            "telephone_number": "626-430-2875",
            "fax_number": "626-331-0035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1359 N GRAND AVE",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917241016",
            "telephone_number": "626-430-2875",
            "fax_number": "626-331-0035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANJA",
        "first_name": "TIFFANY",
        "name_prefix": "Miss",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-24",
        "last_updated": "2020-11-17",
        "certification_date": "2020-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "ASW 17190",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "26769",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Covina, CA

Sources for this page

Verify at the official NPI Registry.