Tiago Barcelos Antonio, LCSW
Individual provider Active NPI Clinical Social Worker · La Mesa, CA
NPI 1194159871 · NPPES record last updated Aug 21, 2023
Key facts
- NPI
- 1194159871
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 90529 (CA)
- Practice address
- 8851 Center Dr Ste 312
La Mesa, CA 91942-3050 - Phone
- (619) 515-2383
- NPI assigned
- Aug 29, 2013
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230621002657 | CA | Practitioner - Clinical Social Worker | 6103284252 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 90529 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Health Centers of San Diego, Inc | Current | Accepting new patients | |
| Family Health Centers of San Diego Inc | Current |
Accepting new patients | |
| Family Health Centers of San Diego, Inc | Current |
Accepting new patients |
Locations
8851 Center Dr
Ste 312
La Mesa, CA 91942
Phone (619) 515-2383
823 Gateway Center Way
San Diego, CA 92102
Phone (619) 515-2323
8788 Jamacha Rd
Spring Valley, CA 91977
Phone (619) 515-2380
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 90529 | CA | Yes |
| Mental Health Counselor | 101YM0800X | 90529 | CA |
Addresses
Primary practice location
8851 Center Dr Ste 312
La Mesa, CA 91942-3050
Mailing address
823 Gateway Center Way
San Diego, CA 92102-4541
Phone (619) 515-2300
Other practice location 1
1679 E Main St Ste 102
El Cajon, CA 92021-5212
Phone (619) 441-1907
Other providers in La Mesa, CA
- Stacey Annand
- Anoushiravan Boghairi MD
- Anthony B Hawkins DC Inc
- Anthony Bledin M.D. Inc
- Anthony P Varboncoeur DDC Inc & Cortland S Caldemeyer DDS Apc GP
- Robert Antonucci
- Apex Recovery, LLC
- Apex Recovery, LLC
- Apex Recovery, LLC
- Apmg Molecular Diagnostics
All providers in La Mesa, CA · Clinical Social Worker in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 21, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.