Individual provider Active NPI

Divinity Star, LCSW

  • Clinical Social Worker
  • Santa Clarita, CA
National Provider Identifier
1124501697
Registry record updated Jul 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
104320 Issued in CA
Practice address
22830 Banyan PL Unit 16
Santa Clarita, CA 91390-4282
Phone
(424) 200-1553
NPI assigned
Sep 11, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 16, 2025

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 104320 CA Primary

Addresses

Primary practice location

22830 Banyan PL Unit 16
Santa Clarita, CA 91390-4282

Mailing address

22830 Banyan PL Unit 16
Santa Clarita, CA 91390-4282
Phone (424) 200-1553

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
I20220131002564 CA Practitioner - Clinical Social Worker 3971996737 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

19950 Rinaldi St
Porter Ranch, CA 91326-4141
Phone (818) 403-2400

26357 McBean Pkwy
Valencia, CA 91355-4488
Phone (661) 222-2600

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
104320CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Facey Medical Foundation Current Accepting new patients
Providence Facey Medical Foundation CurrentSince Feb 7, 2022 Accepting new patients
Providence Facey Medical Foundation CurrentSince Feb 7, 2022 Accepting new patients

Locations

File 50670
Los Angeles, CA 90074

18460 Roscoe Blvd
Northridge, CA 91325
Phone (818) 734-3600

19950 Rinaldi St
Ste 103
Porter Ranch, CA 91326
Phone (818) 403-2400

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

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": "1536624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752624000000",
    "number": "1124501697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22830 BANYAN PL UNIT 16",
            "city": "SANTA CLARITA",
            "state": "CA",
            "postal_code": "913904282",
            "telephone_number": "424-200-1553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22830 BANYAN PL UNIT 16",
            "city": "SANTA CLARITA",
            "state": "CA",
            "postal_code": "913904282",
            "telephone_number": "424-200-1553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAR",
        "first_name": "DIVINITY",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-11",
        "last_updated": "2025-07-16",
        "certification_date": "2025-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "104320",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Clarita, CA

Sources for this page

Verify at the official NPI Registry.