Active NPI
Tina Elizabeth Clark, LCSW
- Clinical Social Worker
- Torrance, CA
National Provider Identifier
1164078069
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 21939
- Practice address
- 23700 Camino del Sol
Torrance, CA 90505-5000 - Phone
- (310) 530-1151
- Fax
- (310) 534-0473
- NPI assigned
- Aug 15, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 21939 | CA | Primary |
Addresses
Primary practice location
23700 Camino del Sol
Torrance, CA 90505-5000
Mailing address
23700 Camino del Sol
Torrance, CA 90505-5000
Phone (310) 530-1151
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21939 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1565827200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565827200000",
"number": "1164078069",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23700 CAMINO DEL SOL",
"city": "TORRANCE",
"state": "CA",
"postal_code": "905055000",
"telephone_number": "310-530-1151",
"fax_number": "310-534-0473"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23700 CAMINO DEL SOL",
"city": "TORRANCE",
"state": "CA",
"postal_code": "905055000",
"telephone_number": "310-530-1151",
"fax_number": "310-534-0473"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "TINA",
"middle_name": "ELIZABETH",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-08-15",
"last_updated": "2019-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "21939",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Torrance, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.