Active NPI
Camille Mansour
- Clinical Social Worker
- San Diego, CA
National Provider Identifier
1740948751
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 6540 Lusk Blvd Ste C200
San Diego, CA 92121-5792 - Phone
- (619) 330-9500
- NPI assigned
- Dec 7, 2021
- 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 | Primary |
Addresses
Primary practice location
6540 Lusk Blvd Ste C200
San Diego, CA 92121-5792
Mailing address
11208 Eagles Creek CT
San Diego, CA 92128-4084
Phone (858) 945-8782
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Sep 26, 2024 through Sep 26, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125842 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1638835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1638835200000",
"number": "1740948751",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11208 EAGLES CREEK CT",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921284084",
"telephone_number": "858-945-8782"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6540 LUSK BLVD STE C200",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921215792",
"telephone_number": "619-330-9500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANSOUR",
"first_name": "CAMILLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-12-07",
"last_updated": "2021-12-07",
"certification_date": "2021-12-07",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.