Individual provider Active NPI

Kristen Marie Penate, LCSW

  • Clinical Social Worker
  • Pomona, CA
National Provider Identifier
1629523295
Registry record updated Jan 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW96449 Issued in CA
Practice address
2008 N Garey Ave
Pomona, CA 91767-2722
Phone
(909) 623-6131
NPI assigned
Aug 23, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LCSW96449 CA Primary

Addresses

Primary practice location

2008 N Garey Ave
Pomona, CA 91767-2722

Mailing address

2008 N Garey Ave
Pomona, CA 91767-2722
Phone (909) 623-6131

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
I20220525000559 CA Practitioner - Clinical Social Worker 3173900552 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCSW96449CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Tri-City Mental Health Authority CurrentSince Jan 25, 2025 Accepting new patients
County of Orange CurrentSince Apr 16, 2022 Accepting new patients
County of Orange CurrentSince Apr 16, 2022 Accepting new patients
Tri-City Mental Health Center PastSince Jan 25, 2025 Accepting new patients

Locations

23228 Madero
Mission Viejo, CA 92691
Phone (949) 454-3940

2008 N Garey Ave
Pomona, CA 91767
Phone (909) 242-7640

14140 Beach Blvd
Ste 223
Westminster, CA 92683
Phone (714) 896-7566

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1471910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738195200000",
    "number": "1629523295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2008 N GAREY AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917672722",
            "telephone_number": "909-623-6131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2008 N GAREY AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917672722",
            "telephone_number": "909-623-6131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENATE",
        "first_name": "KRISTEN",
        "middle_name": "MARIE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-23",
        "last_updated": "2025-01-30",
        "certification_date": "2025-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW96449",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pomona, CA

Sources for this page

Verify at the official NPI Registry.