Miriam Leah Bustamante, LCSW
Individual provider Active NPI Clinical Social Worker · Dana Point, CA
NPI 1447950860 · NPPES record last updated Apr 12, 2023
Key facts
- NPI
- 1447950860
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 88666 (CA)
- Practice address
- 24311 Santa Clara Ave Apt 1
Dana Point, CA 92629-3019 - Phone
- (714) 200-6219
- NPI assigned
- Mar 6, 2023
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Sierra Family Therapy Centers, Inc.
Practice addresses (Care Compare)
673 S Auburn St
Suite B
Grass Valley, CA 95945-7576
Phone (530) 913-5054
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 |
|---|---|---|---|---|
| I20260505001507 | CA | Practitioner - Clinical Social Worker | 9739657180 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 88666 | CA | MD | Professional Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 88666 | CA | Yes |
Addresses
Primary practice location
24311 Santa Clara Ave Apt 1
Dana Point, CA 92629-3019
Mailing address
24311 Santa Clara Ave Apt 1
Dana Point, CA 92629-3019
Phone (714) 200-6219
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 88666 | Other | CA | BBS |
Other providers in Dana Point, CA
- Lewis L Bruggeman
- Angeline Bryan
- Oksana V Bublik
- Jason Buchanan Buchanan
- Fred Hurd Burbank
- Elian Cabrera-Nguyen
- Tyler Cannella
- Chelsea Caraway
- Dennise Carbajal
- Meredith Kathleen Carrillo
All providers in Dana Point, 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 Apr 12, 2023. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.