Takenya Chimene Clark-Jefferies, LCSW
Individual provider Active NPI Social Worker · Grand Terrace, CA
NPI 1205087657 · NPPES record last updated Aug 22, 2023
Key facts
- NPI
- 1205087657
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- LCS#62241 (CA)
- Practice address
- 12139 Mount Vernon Ave Ste 104
Grand Terrace, CA 92313-5500 - Phone
- (909) 452-5857
- Fax
- (909) 527-4811
- NPI assigned
- Oct 3, 2008
- Sex
- Female
- 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 |
|---|---|---|---|---|
| I20190409000948 | CA | Practitioner - Clinical Social Worker | 5092056697 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCS#62241 | CA | MD | Social Worker |
| 62241 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Neighborhood Healthcare | Current |
Accepting new patients | |
| Terra Vista Counseling | Current |
Accepting new patients | |
| Neighborhood Healthcare | Current |
Accepting new patients |
Locations
425 N Date St
Escondido, CA 92025
Phone (760) 737-2035
12139 Mount Vernon Ave
Ste 104
Grand Terrace, CA 92313
Phone (909) 452-5857
10601 Church St
Ste 124
Rancho Cucamonga, CA 91730
Phone (626) 755-7041
26926 Cherry Hills Blvd
Ste B
Sun City, CA 92586
Phone (909) 301-9188
41840 Enterprise Cir N
Temecula, CA 92590
Phone (951) 225-6400
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | LCS#62241 | CA | Yes |
Addresses
Primary practice location
12139 Mount Vernon Ave Ste 104
Grand Terrace, CA 92313-5500
Mailing address
PO Box 1361
Bloomington, CA 92316-0380
Phone (909) 452-5857
Other names
- Takenya Chimene Clark
Other providers in Grand Terrace, CA
- CG Physical Therapy Services Inc
- Charms Property Incorporated
- Grace Griselda Chavez
- Richard S. Cho
- Erica Choi
- Paulette D Coates
- Cynthia Contreras
- Annette Coria
- Marileth Coria
- Anthony Cortez
All providers in Grand Terrace, CA · 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 22, 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.