Janice Derderian Licensed Clinical Social Worker Inc

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW7388 Issued in CA

Legal business name

JANICE DERDERIAN LICENSED CLINICAL SOCIAL WORKER INC

Practice address

1661 Golden Rain Rd
Seal Beach, CA 90740-4907

Phone

(562) 795-6300

NPI assigned

Sep 24, 2007

Last updated

Sep 24, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Janice Derderian, LCSW

Title

Owner

Phone

(562) 795-6300

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1190592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190592000000",
    "number": "1700072717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2685",
            "city": "SEAL BEACH",
            "state": "CA",
            "postal_code": "907401685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1661 GOLDEN RAIN RD",
            "city": "SEAL BEACH",
            "state": "CA",
            "postal_code": "907404907",
            "telephone_number": "562-795-6300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JANICE DERDERIAN LICENSED CLINICAL SOCIAL WORKER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-24",
        "last_updated": "2007-09-24",
        "status": "A",
        "authorized_official_last_name": "DERDERIAN",
        "authorized_official_first_name": "JANICE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "562-795-6300",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "SW7388",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Seal Beach, CA
• Providers in Seal Beach, 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 Sep 24, 2007; 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.