Gina Marie Clark, ACSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

29038 Issued in CA

Practice address

1008 W Avenue J10
Lancaster, CA 93534-4828

Phone

(661) 341-3900

NPI assigned

Feb 5, 2009

Last updated

May 31, 2011By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Gina Marie Walden Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pathways Community Services LLC

  dba CYS Clarvida - Tustin

  • Community/Behavioral Health Agency
  • Tustin, CA
  • NPI 1396436077
  NPD (past)

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

{
    "created_epoch": "1233792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1306800000000",
    "number": "1871732412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1008 W AVENUE J10",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935344828",
            "telephone_number": "661-341-3900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1008 W AVENUE J10",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935344828",
            "telephone_number": "661-341-3900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "GINA",
        "middle_name": "MARIE",
        "credential": "ACSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-02-05",
        "last_updated": "2011-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CA",
            "license": "29038",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GINA",
            "last_name": "WALDEN",
            "middle_name": "MARIE",
            "credential": "ACSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Michael Anthony Cirillo
• Maria Cristina Cisneros, DMD, MS
• City of Hope Medical Foundation (City of Hope Antelope Valley)
• CK I, Inc. (CK I)
• CK II, Inc. (CK II)
• Jeffrey Jay Clark, OD
• Kennyae Dynae Clark
• Kimberly Roshawn Clark
• Lacey Clark, LCSW
• Mavis J. Clark

• Social Worker in Lancaster, CA
• Providers in Lancaster, CA by specialty
• Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2011; 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.