Stephanie Ellis, Licensed Clinical Social Worker, P.C.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

STEPHANIE ELLIS, LICENSED CLINICAL SOCIAL WORKER, P.C.

Practice address

30290 Buccaneer Bay Unit D
Murrieta, CA 92563-8812

Phone

(951) 246-6152

NPI assigned

Feb 11, 2021

Organization subpart

No

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

Authorized official

Name

Mr. Dana D Ellis Sr.

Title

Business Manager

Phone

(951) 246-6152

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Locations

Interoperability endpoints

• Direct secure messaging: lcswtherapist@yourimperfectlyperfect.com

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

{
    "created_epoch": "1613001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613001600000",
    "number": "1326630203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29910 MURRIETA HOT SPRINGS RD STE G304",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "925633814",
            "telephone_number": "951-246-6152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30290 BUCCANEER BAY UNIT D",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "925638812",
            "telephone_number": "951-246-6152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEPHANIE ELLIS, LICENSED CLINICAL SOCIAL WORKER, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-11",
        "last_updated": "2021-02-11",
        "certification_date": "2021-02-11",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "DANA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "951-246-6152",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr."
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPES",
            "identifier": "1730625294",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "LCSWtherapist@yourimperfectlyperfect.com",
            "affiliation": "N",
            "endpointDescription": "email address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email message",
            "address_1": "30290 Buccaneer Bay Unit D",
            "city": "Murrieta",
            "state": "CA",
            "country_code": "US",
            "postal_code": "925638812",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Clinical Social Worker in Murrieta, CA
• Providers in Murrieta, 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 Feb 11, 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.

Verify at the official NPI Registry.