Denice Campos
Individual provider Active NPI Clinical Social Worker · Pico Rivera, CA
NPI 1306456173 · NPPES record last updated Oct 12, 2024
Key facts
- NPI
- 1306456173
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- LCSW121645 (CA)
- Practice address
- 8622 Coffman Pico Rd
Pico Rivera, CA 90660-3202 - Phone
- (323) 303-6131
- NPI assigned
- Aug 5, 2020
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 6
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 |
|---|---|---|---|---|
| I20241018002001 | CA | Practitioner - Clinical Social Worker | 2365974029 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW121645 | CA | MD | Clinical Social Worker |
| 121645 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern California Permanente Medical Group | Current | Accepting new patients | |
| Pacific Clinics | Current |
Accepting new patients | |
| Southern California Permanente Medical Group | Current |
Accepting new patients | |
| Southern California Permanente Medical Group | Current |
Accepting new patients | |
| Southern California Permanente Medical Group | Current |
Accepting new patients | |
| Southern California Permanente Medical Group | Current | Accepting new patients |
Locations
9961 Sierra Ave
Fontana, CA 92335
Phone (909) 427-3910
4733 W Sunset Blvd
Los Angeles, CA 90027
Phone (213) 667-4784
4760 W Sunset Blvd
Los Angeles, CA 90027
Phone (323) 783-0567
393 E Walnut St
Unit 3RD
Pasadena, CA 91188
Phone (626) 405-7914
2550 E Foothill Blvd
Pasadena, CA 91107
Phone (626) 744-5242
393 E Walnut St
Pasadena, CA 91188
Phone (626) 405-7914
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LCSW121645 | CA | |
| Mental Health Counselor | 101YM0800X | |||
| Clinical Social Worker | 1041C0700X | LCSW121645 | CA | Yes |
| Rehabilitation Practitioner | 225400000X | |||
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
8622 Coffman Pico Rd
Pico Rivera, CA 90660-3202
Mailing address
8622 Coffman Pico Rd
Pico Rivera, CA 90660-3202
Phone (323) 303-6131
Other practice location 1
393 E Walnut St
Pasadena, CA 91188-3202
Phone (833) 511-0106
Other practice location 2
2550 E Foothill Blvd
Pasadena, CA 91107-3406
Phone (626) 744-5245
Other practice location 3
2121 W Temple St
Los Angeles, CA 90026-4915
Phone (213) 385-5100
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq | Health Information Exchange (HIE) | Southern California Permanente Medical Group |
Other providers in Pico Rivera, CA
- Linda Franco Bustamante
- Priscila Caceda
- Cali Assisted Transportation Inc.
- California Hispanic Commission a & D Abuse
- Camacho and Zaklama Dental Corporation
- Julia Isabel Canizal
- Angelica Cano
- Juan Cano
- Fernando Basco Canon
- Johanna G Caprietta
All providers in Pico Rivera, 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 Oct 12, 2024. 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.