Individual provider Active NPI

Wanda Pathomrit, LCSW

  • Clinical Social Worker
  • Van Nuys, CA
National Provider Identifier
1205338639
Registry record updated Feb 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW113153 Issued in CA
Practice address
15350 Sherman Way Ste 200
Van Nuys, CA 91406-4458
Phone
(818) 267-1100
NPI assigned
Mar 1, 2018
Last updated
Feb 28, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X ACSW106131 CA
Mental Health Counselor 101YM0800X 69847 CA
Clinical Social Worker 1041C0700X LCSW113153 CA Primary
Rehabilitation Practitioner 225400000X NU

Addresses

Primary practice location

15350 Sherman Way Ste 200
Van Nuys, CA 91406-4458

Mailing address

15350 Sherman Way Ste 200
Van Nuys, CA 91406-4458

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
I20230420001872 CA Practitioner - Clinical Social Worker 0345605689 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Special Service for Groups IncGroup PAC ID 2769396886, 61 clinicians

Practice addresses (Care Compare)

15350 Sherman Way
Suite 200
Van Nuys, CA 91406-4458
Phone (818) 367-1100

520 S Lafayette Park PL
FL 3
Los Angeles, CA 90057-5400
Phone (213) 252-2100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ACSW106131CAMDMental Health Counselor
113153CAMDProfessional Counselor
LCSW113153CAMDClinical Social Worker
69847CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Special Service for Groups, Inc. CurrentSince Jan 14, 2023 Accepting new patients
Special Service for Groups, Inc. Current Accepting new patients
Special Service for Groups, Inc. CurrentSince Jan 14, 2023 Accepting new patients
Special Service for Groups, Inc. Past Accepting new patients

Locations

905 E 8th St
Los Angeles, CA 90021
Phone (213) 553-1800

15350 Sherman Way
Ste 200
Van Nuys, CA 91406
Phone (818) 267-1100

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1519862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677542400000",
    "number": "1205338639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15350 SHERMAN WAY STE 200",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914064458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15350 SHERMAN WAY STE 200",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914064458",
            "telephone_number": "818-267-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATHOMRIT",
        "first_name": "WANDA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-01",
        "last_updated": "2023-02-28",
        "certification_date": "2023-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "ACSW106131",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "69847",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW113153",
            "primary": true
        },
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Van Nuys, CA

Sources for this page

Verify at the official NPI Registry.