Active NPI
Lynne Michelle Dacosta, L.C.S.W.
- Clinical Social Worker
- Banning, CA
National Provider Identifier
1629150628
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 21205
- Practice address
- 1627 S Hargrave St
Banning, CA 92220-6169 - Phone
- (951) 922-7840
- Fax
- (951) 922-7752
- NPI assigned
- Oct 19, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 21205 | CA | Primary |
Addresses
Primary practice location
1627 S Hargrave St
Banning, CA 92220-6169
Mailing address
2085 Rustin Ave Ste 1
Riverside, CA 92507-2498
Phone (951) 955-7320
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LCS 21205 | Other | CA | L.C.S.W. |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21205 | CA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1618358400000",
"number": "1629150628",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2085 RUSTIN AVE STE 1",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925072498",
"telephone_number": "951-955-7320"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1627 S HARGRAVE ST",
"city": "BANNING",
"state": "CA",
"postal_code": "922206169",
"telephone_number": "951-922-7840",
"fax_number": "951-922-7752"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DACOSTA",
"first_name": "LYNNE",
"middle_name": "MICHELLE",
"name_prefix": "Mrs.",
"credential": "L.C.S.W.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-19",
"last_updated": "2021-04-14",
"certification_date": "2021-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "21205",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "L.C.S.W.",
"identifier": "LCS 21205",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Banning, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 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.