Carolyn Grace Cledera, LCSW #76937

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

76937 Issued in CA

Practice address

301 Victoria St
Costa Mesa, CA 92627-1995

Phone

(499) 642-2734

Fax

(949) 999-6192

NPI assigned

Aug 21, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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 and National Provider Directory roles.

• Center for New Directions, Inc.

  • Mental Health Counselor
  • Laguna Hills, CA
  • NPI 1578121190
  NPD
• Michele Lob, a Professional Corporation

  • Community/Behavioral Health Agency
  • Newport Beach, CA
  • NPI 1174075675
  NPD (past)

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

{
    "created_epoch": "1503273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695686400000",
    "number": "1114443264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10433",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926270161",
            "telephone_number": "949-697-9992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 VICTORIA ST",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926271995",
            "telephone_number": "499-642-2734",
            "fax_number": "949-999-6192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEDERA",
        "first_name": "CAROLYN",
        "middle_name": "GRACE",
        "name_prefix": "Mrs.",
        "credential": "LCSW #76937",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-21",
        "last_updated": "2023-09-26",
        "certification_date": "2023-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "76937",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clean & Sober Living Corp
• Clean Path Recovery, LLC
• Clean Testing Services
• Clear Choice Helpuhear, Inc.
• Clear Detox Center Inc.
• Stephanie Clements
• Joey Lynn Clevenger
• Erika Angeline Clever, LMFT
• Demaris Climax
• Clint Walker Dental Corporation

• Clinical Social Worker in Costa Mesa, CA
• Providers in Costa Mesa, 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 Sep 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.