Active NPI
Chaka Khan Denise Theus, LCSW
- Clinical Social Worker
- Palmdale, CA
National Provider Identifier
1306197066
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 76678
- Practice address
- 2323A E Palmdale Blvd
Palmdale, CA 93550-4957 - Phone
- (213) 247-6678
- NPI assigned
- Sep 20, 2012
- 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 | 76678 | CA | Primary |
Addresses
Primary practice location
2323A E Palmdale Blvd
Palmdale, CA 93550-4957
Mailing address
2323A E Palmdale Blvd
Palmdale, CA 93550-4957
Phone (323) 895-9005
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00000000 | Other | MEDICAL |
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 |
|---|---|---|---|
| 76678 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348099200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620086400000",
"number": "1306197066",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2323A E PALMDALE BLVD",
"city": "PALMDALE",
"state": "CA",
"postal_code": "935504957",
"telephone_number": "323-895-9005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2323A E PALMDALE BLVD",
"city": "PALMDALE",
"state": "CA",
"postal_code": "935504957",
"telephone_number": "213-247-6678"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THEUS",
"first_name": "CHAKA KHAN",
"middle_name": "DENISE",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-09-20",
"last_updated": "2021-05-04",
"certification_date": "2021-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "76678",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL",
"identifier": "00000000",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Palmdale, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.