Individual provider Active NPI

Christina Melissa Tait, LCSW

  • Clinical Social Worker
  • Rancho Cucamonga, CA
National Provider Identifier
1417074485
Registry record updated Jul 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
79089 Issued in CA
Practice address
9500 Haven Ave
Rancho Cucamonga, CA 91730-5807
Phone
(909) 980-6700
NPI assigned
Mar 23, 2007
Last updated
Jul 22, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 79089 CA Primary

Addresses

Primary practice location

9500 Haven Ave
Rancho Cucamonga, CA 91730-5807

Mailing address

25910 Acero Ste 160
Mission Viejo, CA 92691-2777
Phone (877) 744-5826

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

NPI Registry JSON

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658448000000",
    "number": "1417074485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25910 ACERO STE 160",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926912777",
            "telephone_number": "877-744-5826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9500 HAVEN AVE",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917305807",
            "telephone_number": "909-980-6700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAIT",
        "first_name": "CHRISTINA",
        "middle_name": "MELISSA",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-23",
        "last_updated": "2022-07-22",
        "certification_date": "2022-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "79089",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Cucamonga, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2022; 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.