Individual provider Active NPI

Joseph Stephen McConico, MSW, LCSW

  • Clinical Social Worker
  • San Diego, CA
National Provider Identifier
1619580057
Registry record updated Feb 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW96008 Issued in CA
Practice address
591 Camino de la Reina Ste 210
San Diego, CA 92108-3104
Phone
(619) 206-5271
Fax
(619) 795-3274
NPI assigned
Aug 25, 2020
Last updated
Feb 17, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 17, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X C009649 NC
Clinical Social Worker 1041C0700X LCSW96008 CA Primary

Addresses

Primary practice location

591 Camino de la Reina Ste 210
San Diego, CA 92108-3104

Mailing address

3952D Clairemont Mesa Blvd # 452
San Diego, CA 92117-2714
Phone (704) 608-9379

Other practice location 1

5274 Mount Alifan Dr
San Diego, CA 92111-2621
Phone (704) 608-9379

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
LCSW96008CAMDClinical Social Worker
C009649NCMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
The Khachatryan Corporation, Licensed Professional Clinical Counselor CurrentSince Feb 21, 2021 Accepting new patients

Locations

591 Camino de la Reina
Ste 210
San Diego, CA 92108
Phone (619) 206-5271

Organizations & group practices 1

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": "1598313600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613520000000",
    "number": "1619580057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3952D CLAIREMONT MESA BLVD # 452",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921172714",
            "telephone_number": "704-608-9379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "591 CAMINO DE LA REINA STE 210",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921083104",
            "telephone_number": "619-206-5271",
            "fax_number": "619-795-3274"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5274 Mount Alifan Dr",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921112621",
            "country_code": "US",
            "telephone_number": "704-608-9379",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCONICO",
        "first_name": "JOSEPH",
        "middle_name": "STEPHEN",
        "credential": "MSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-08-25",
        "last_updated": "2021-02-17",
        "certification_date": "2021-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C009649",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW96008",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.