Restore Mental Wellness, Licensed Clinical Social Worker, Inc

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

RESTORE MENTAL WELLNESS, LICENSED CLINICAL SOCIAL WORKER, INC

Practice address

22521 Scarlet Sage Way
Moreno Valley, CA 92557-5921

Phone

(562) 556-1312

NPI assigned

Feb 10, 2025

Organization subpart

No

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

Authorized official

Name

Mrs. Dianitza Medina, LCSWNPI 1902064074

Title

Ceo

Phone

(562) 556-1312

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Dianitza Medina, LCSW

  • Clinical Social Worker
  • San Diego, CA
  • NPI 1902064074
  NPD Authorized official

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

{
    "created_epoch": "1739145600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739145600000",
    "number": "1649085507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13502 WHITTIER BLVD # H232",
            "city": "WHITTIER",
            "state": "CA",
            "postal_code": "906051945",
            "telephone_number": "562-556-1312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22521 SCARLET SAGE WAY",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925575921",
            "telephone_number": "562-556-1312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORE MENTAL WELLNESS, LICENSED CLINICAL SOCIAL WORKER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-10",
        "last_updated": "2025-02-10",
        "certification_date": "2025-02-09",
        "status": "A",
        "authorized_official_last_name": "MEDINA",
        "authorized_official_first_name": "DIANITZA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "562-556-1312",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1902064074",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marquise Reneau
• Renewed Grace Restoration LLC
• Ofelia Reotan Rentoria, RPH
• Corina Resabala Villacis
• Erica Respress
• Bonnie J. Retamozo, DDS, MSD
• Alejandro A Reyes
• Angel Reyes
• Delia Zambrano Reyes, NP
• Guadalupe Reyes

• Clinical Social Worker in Moreno Valley, CA
• Providers in Moreno Valley, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2025; 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.