Source Therapy Licensed Clinical Social Worker Services Apc

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

27130 Issued in CA

Legal business name

SOURCE THERAPY LICENSED CLINICAL SOCIAL WORKER SERVICES APC

Practice address

1582 W San Marcos Blvd Ste 105
San Marcos, CA 92078-4081

Phone

(760) 522-7158

Fax

(760) 539-7357

NPI assigned

May 2, 2018

Organization subpart

No

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

Authorized official

Name

Carolyn Bowe-McLeod

Title

Billing Manager

Phone

(760) 433-7944

Specialties & licenses 1

Addresses

Other names 1

• Michelle M. Colarusso, LCSW Doing business as

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

{
    "created_epoch": "1525219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676592000000",
    "number": "1740779164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1582 W SAN MARCOS BLVD STE 105",
            "city": "SAN MARCOS",
            "state": "CA",
            "postal_code": "920784081",
            "telephone_number": "760-522-7158",
            "fax_number": "760-539-7357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1582 W SAN MARCOS BLVD STE 105",
            "city": "SAN MARCOS",
            "state": "CA",
            "postal_code": "920784081",
            "telephone_number": "760-522-7158",
            "fax_number": "760-539-7357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOURCE THERAPY LICENSED CLINICAL SOCIAL WORKER SERVICES APC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-02",
        "last_updated": "2023-02-17",
        "certification_date": "2022-06-16",
        "status": "A",
        "authorized_official_last_name": "BOWE-MCLEOD",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "760-433-7944"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "27130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Michelle M. Colarusso, LCSW",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jaren Kasey Soloff, RD
• Soma Physical Therapy Inc
• Eva L Sorensen, M.D.
• Abraham Soto
• Alejandro Soto, M.D.
• Megan Southerly, LVN
• Bryn Sovacool
• Jennifer Spahr
• Special Education Services
• Jamie Fukai Spence, PA-C

• Clinical Social Worker in San Marcos, CA
• Providers in San Marcos, 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 17, 2023; 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.