Individual provider Active NPI

Daniel D Wongthavatchai, LCSW

  • Clinical Social Worker
  • Arcadia, CA
National Provider Identifier
1790064012
Registry record updated Apr 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
88422 Issued in CA
Practice address
41 E Foothill Blvd
Ste 102
Arcadia, CA 91006-2361
Phone
(626) 701-4249
Fax
(626) 737-6034
NPI assigned
Aug 4, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 17, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 33235 CA
Clinical Social Worker 1041C0700X 88422 CA Primary

Addresses

Primary practice location

41 E Foothill Blvd
Ste 102
Arcadia, CA 91006-2361

Mailing address

41 E Foothill Blvd
Ste 102
Arcadia, CA 91006-2361
Phone (626) 701-4249

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
I20200417002356 CA Practitioner - Clinical Social Worker 4486084258 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Soultenders IncGroup PAC ID 6507170453, 113 clinicians

Practice addresses (Care Compare)

41 E Foothill Blvd
Suite 102
Arcadia, CA 91006-2361
Phone (626) 701-4249

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
88422CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Soultenders, Inc. Mental Health CurrentSince Mar 1, 2020 Accepting new patients

Locations

41 E Foothill Blvd
Ste 102
Arcadia, CA 91006
Phone (626) 701-4249

Organizations & group practices 1

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": "1312416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587081600000",
    "number": "1790064012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 E FOOTHILL BLVD",
            "address_2": "STE 102",
            "city": "ARCADIA",
            "state": "CA",
            "postal_code": "910062361",
            "telephone_number": "626-701-4249",
            "fax_number": "626-737-6034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41 E FOOTHILL BLVD",
            "address_2": "STE 102",
            "city": "ARCADIA",
            "state": "CA",
            "postal_code": "910062361",
            "telephone_number": "626-701-4249",
            "fax_number": "626-737-6034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONGTHAVATCHAI",
        "first_name": "DANIEL",
        "middle_name": "D",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-08-04",
        "last_updated": "2020-04-17",
        "certification_date": "2020-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "33235",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "88422",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Arcadia, CA

Sources for this page

Verify at the official NPI Registry.