The Practice Counseling Services Licensed Clinical Social Worker, PC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

70176 Issued in CA

Legal business name

THE PRACTICE COUNSELING SERVICES LICENSED CLINICAL SOCIAL WORKER, PC

Practice address

1000 Texas St Ste D
Fairfield, CA 94533

Phone

(562) 587-7409

NPI assigned

Mar 8, 2018

Organization subpart

No

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

Authorized official

Name

Mara Sammartino, LCSW

Title

Office Manager

Phone

(562) 587-7409

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 2

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

• Audrey N Reyes, LCSW

  • Clinical Social Worker
  • Vacaville, CA
  • NPI 1215440656
  Medicare reassignment NPD
• Charlene Maria Phipps, LCSW

  • Clinical Social Worker
  • Fairfield, CA
  • NPI 1740593037
  NPD

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

{
    "created_epoch": "1520467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530835200000",
    "number": "1831692573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 TEXAS ST STE D",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945335700",
            "telephone_number": "562-587-7409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 TEXAS ST STE D",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "94533",
            "telephone_number": "562-587-7409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PRACTICE COUNSELING SERVICES LICENSED CLINICAL SOCIAL WORKER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-08",
        "last_updated": "2018-07-06",
        "status": "A",
        "authorized_official_last_name": "SAMMARTINO",
        "authorized_official_first_name": "MARA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "562-587-7409",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "70176",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "71187",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "79256",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "69929",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Debra D. Terry, LMFT
• Thomas H Teryl, D.C.
• Glecy Tesico
• The Oasis Home Inc
• The Oasis Home Inc
• Nancy Theis
• Therapy Specialists
• Therapy Specialists
• Alice Lane Therrell, RN, FNP-BC
• Eleanor Theurer

• Clinical Social Worker in Fairfield, CA
• Providers in Fairfield, 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 Jul 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.