Individual provider Active NPI

Georgina Kasih

  • Clinical Social Worker
  • Fontana, CA
National Provider Identifier
1467920108
Registry record updated May 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
114291 Issued in CA
Practice address
17035 San Bernardino Ave Apt 14
Fontana, CA 92335-6743
Phone
(559) 901-6422
Fax
(559) 901-6422
NPI assigned
Nov 12, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X ASW83618 CA
Clinical Social Worker 1041C0700X 114291 CA Primary

Addresses

Primary practice location

17035 San Bernardino Ave Apt 14
Fontana, CA 92335-6743

Mailing address

17035 San Bernardino Ave Apt 14
Fontana, CA 92335-6743
Phone (559) 901-6422

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230607001690 CA Practitioner - Clinical Social Worker 4688031610 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ASW83618CAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Grow Healthcare Group PC Mental Health CurrentSince May 12, 2023 Accepting new patients
Amanecer Community Counseling Service, a Non-Profit Corporation PastSince Jul 1, 2022 Accepting new patients
Amanecer Community Counseling Service, a Non-Profit Corporation PastSince Mar 21, 2021 Accepting new patients

Locations

99 Almaden Blvd
Ste 600
San Jose, CA 95113
Phone (408) 402-4385

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1541980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684368000000",
    "number": "1467920108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17035 SAN BERNARDINO AVE APT 14",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923356743",
            "telephone_number": "559-901-6422",
            "fax_number": "559-901-6422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17035 SAN BERNARDINO AVE APT 14",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923356743",
            "telephone_number": "559-901-6422",
            "fax_number": "559-901-6422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KASIH",
        "first_name": "GEORGINA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-12",
        "last_updated": "2023-05-18",
        "certification_date": "2023-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "ASW83618",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "114291",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fontana, CA

Sources for this page

Verify at the official NPI Registry.