Individual provider Active NPI

David Lee

  • Clinical Social Worker
  • Santa Fe Springs, CA
National Provider Identifier
1548624109
Registry record updated Apr 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW114865 Issued in CA
Practice address
11721 Telegraph Rd
Santa Fe Springs, CA 90670-3674
Phone
(562) 949-8455
NPI assigned
Apr 11, 2016
Last updated
Apr 25, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 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 ASW89297 CA
Clinical Social Worker 1041C0700X LCSW114865 CA Primary

Addresses

Primary practice location

11721 Telegraph Rd
Santa Fe Springs, CA 90670-3674

Mailing address

3217 Phelps Ave
Los Angeles, CA 90032-2122
Phone (626) 551-7975

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
I20230605001634 CA Practitioner - Clinical Social Worker 7618334772 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pacific ClinicsGroup PAC ID 4082008420, 72 clinicians

Practice addresses (Care Compare)

11721 Telegraph Rd
Suite a
Santa Fe Springs, CA 90670-6835
Phone (562) 949-8455

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ASW89297CAMDMental Health Counselor
LCSW114865CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Pacific Clinics Case Manager/Care Coordinator Current Accepting new patients
Pacific Clinics Case Manager/Care Coordinator CurrentSince Apr 18, 2023 Accepting new patients
Pacific Clinics Case Manager/Care Coordinator CurrentSince Apr 18, 2023 Accepting new patients
Pacific Clinics Case Manager/Care Coordinator PastSince Dec 12, 2021 Accepting new patients

Locations

251 Llewellyn Ave
Campbell, CA 95008
Phone (408) 364-4083

1020 S Arroyo Pkwy
Pasadena, CA 91105
Phone (626) 403-2794

11721 Telegraph Rd
Ste A
Santa Fe Springs, CA 90670
Phone (562) 949-8355

11741 Telegraph Rd
Ste Abc
Santa Fe Springs, CA 90670
Phone (562) 801-0318

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1460332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682380800000",
    "number": "1548624109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3217 PHELPS AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900322122",
            "telephone_number": "626-551-7975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11721 TELEGRAPH RD",
            "city": "SANTA FE SPRINGS",
            "state": "CA",
            "postal_code": "906703674",
            "telephone_number": "562-949-8455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "DAVID",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-11",
        "last_updated": "2023-04-25",
        "certification_date": "2023-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "ASW89297",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW114865",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Fe Springs, CA

Sources for this page

Verify at the official NPI Registry.