Malia Fendy Guillaume-Wilson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

108147 Issued in CA

Practice address

3443 Camino del Rio S Ste 325
San Diego, CA 92108-3915

Phone

(305) 776-2167

NPI assigned

Jun 9, 2022

Last updated

Jun 9, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Grow Healthcare Group PC

  • Mental Health Counselor
  • San Jose, CA
  • NPI 1154994846

  Clinical

  NPD

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

{
    "created_epoch": "1654732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654732800000",
    "number": "1417686817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3443 CAMINO DEL RIO S STE 325",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921083915",
            "telephone_number": "305-776-2167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3443 CAMINO DEL RIO S STE 325",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921083915",
            "telephone_number": "305-776-2167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUILLAUME-WILSON",
        "first_name": "MALIA",
        "middle_name": "FENDY",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-06-09",
        "last_updated": "2022-06-09",
        "certification_date": "2022-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "108147",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Haley Guiffrida, MPH,CHES,CWHC,CPT
• Valeria Fernanda Guijarro Acosta
• Stacey Ann Guijo, OTR/L
• Ashley Guilbeau, PHARMD
• Athea Guilfoyle, RD
• Marie Guillaume
• Daisy Guillen Fonseca
• Ivanova Guillen, PTA
• Lissette Guillen
• Rogelio Israel Guillen I

• Clinical Social Worker in San Diego, CA
• Providers in San Diego, 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 Jun 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.