Dmitriy Victor Puchkarev, ASW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

127235 Issued in CA

Practice address

503 Ocean Front Walk
Venice, CA 90291-2403

Phone

(310) 392-3070

Fax

(310) 452-8766

NPI assigned

Oct 29, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Dima Puchkarev Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Phoenix Houses of Los Angeles, Inc.

  • Substance Abuse Rehabilitation Facility
  • Venice, CA
  • NPI 1497809735
  NPD (past)
• Twin Town Corporation

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Torrance, CA
  • NPI 1861828600
  NPD (past)

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

{
    "created_epoch": "1603929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754265600000",
    "number": "1215537121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10943 NATIONAL BLVD APT 6",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900644052",
            "telephone_number": "858-213-9391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503 OCEAN FRONT WALK",
            "city": "VENICE",
            "state": "CA",
            "postal_code": "902912403",
            "telephone_number": "310-392-3070",
            "fax_number": "310-452-8766"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10943 National Blvd Apt 6",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900644052",
            "country_code": "US",
            "telephone_number": "858-213-9391",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PUCHKAREV",
        "first_name": "DMITRIY",
        "middle_name": "VICTOR",
        "name_prefix": "Mr.",
        "credential": "ASW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-10-29",
        "last_updated": "2025-08-04",
        "certification_date": "2025-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "127235",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DIMA",
            "last_name": "PUCHKAREV",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Caron Sue Post, PHD
• Heidi Potter, SUDRC
• Praesidium Diagnostic LLC
• Prehab2Perform Physical Therapy PC
• Kelly Elizabeth Preston, ACSW
• Benjawan Punyaporn
• Karen Quindara
• Jose Quiroga, M.D.
• David Stephen Radcliff, LVN
• Thomas Rhoades Rader

• Clinical Social Worker in Venice, CA
• Providers in Venice, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.