My Deliverance Is Freedom Licensed Clinical Social Worker, Inc

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

MY DELIVERANCE IS FREEDOM LICENSED CLINICAL SOCIAL WORKER, INC

Doing business as

My Deliverance is Freedom Licensed Clinical Social Worker, inc
My Deliverance is Freedom, inc

Practice address

16041 Kamana Rd Ste a
Apple Valley, CA 92307-1331

Phone

(760) 552-9556

NPI assigned

Oct 22, 2021

Organization subpart

No

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

Authorized official

Name

Myra Dina Lopez, LCSWNPI 1023572583

Title

Owner/Ceo

Phone

(760) 552-9556

Specialties & licenses 1

Addresses

Other names 2

• My Deliverance is Freedom Licensed Clinical Social Worker, inc Doing business as
• My Deliverance is Freedom, inc Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Myra Dina Lopez, ACSW

  • Clinical Social Worker
  • Victorville, CA
  • NPI 1023572583
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1634860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655942400000",
    "number": "1427712835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16041 KAMANA RD STE A",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923071331",
            "telephone_number": "760-552-9556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16041 KAMANA RD STE A",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923071331",
            "telephone_number": "760-552-9556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY DELIVERANCE IS FREEDOM LICENSED CLINICAL SOCIAL WORKER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-22",
        "last_updated": "2022-06-23",
        "certification_date": "2022-06-16",
        "status": "A",
        "authorized_official_last_name": "LOPEZ",
        "authorized_official_first_name": "MYRA",
        "authorized_official_middle_name": "DINA",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "760-552-9556",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "My Deliverance is Freedom Licensed Clinical Social Worker, inc",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "My Deliverance is Freedom, inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Gopal Krishnarao Nagasamudram, MS, CCC-SPEECH PATHO
• Joshua Nam, MSOT OTR/L

• Clinical Social Worker in Apple Valley, CA
• Providers in Apple Valley, 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 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.