Carly Santos Blalack, LCSW, PPS

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

29364 Issued in CA

Practice address

4700 Spring St Ste 220
La Mesa, CA 91942-0274

Phone

(619) 667-3380

Fax

(619) 667-0815

NPI assigned

Sep 24, 2010

Last updated

Aug 21, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Carly Elisabeth Santos Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: carly.blalack.d2.p1@direct.pcsd.nextgenshare.com

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.

• Family Health Centers of San Diego Inc

  dba Beach Area Family Health Center Annex

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
  • NPI 1184982159
  NPD
• Family Health Centers of San Diego, Inc

  dba Escondido Physical Health and Wellness

  • Federally Qualified Health Center (FQHC)
  • Escondido, CA
  • NPI 1356178180
  NPD
• Family Health Centers of San Diego, Inc

  dba El Cajon Youth Counseling Center

  • Federally Qualified Health Center (FQHC)
  • El Cajon, CA
  • NPI 1356983241
  NPD
• Family Health Centers of San Diego, Inc

  dba Logan Heights Family Health Center

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
  • NPI 1447281936
  NPD

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

{
    "created_epoch": "1285286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692576000000",
    "number": "1871801803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3835 N FREEWAY BLVD STE 100",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958341954",
            "telephone_number": "916-576-7900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 SPRING ST STE 220",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919420274",
            "telephone_number": "619-667-3380",
            "fax_number": "619-667-0815"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2010 Winterwarm Dr",
            "address_purpose": "LOCATION",
            "city": "Fallbrook",
            "state": "CA",
            "postal_code": "920288257",
            "country_code": "US",
            "telephone_number": "949-231-8362",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "680 Fletcher Pkwy Ste 200",
            "address_purpose": "LOCATION",
            "city": "El Cajon",
            "state": "CA",
            "postal_code": "920202500",
            "country_code": "US",
            "telephone_number": "619-515-2365",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLALACK",
        "first_name": "CARLY",
        "middle_name": "SANTOS",
        "name_prefix": "Mrs.",
        "credential": "LCSW, PPS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-24",
        "last_updated": "2023-08-21",
        "certification_date": "2023-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "29364",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARLY",
            "last_name": "SANTOS",
            "middle_name": "ELISABETH",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Bina Adigopula, MD, Inc. (Grossmont Pediatrics, Inc.)
• Biosolutions Clinical Research Center
• Courtney Birtwistle, FNP-C
• Bishop Mental Health, a Professional Nursing Corporation
• Madison C Blades
• Katherine Blanchard
• Deanna Bloom
• Diane Wade Bloomberg, MS, RDN, CNSC
• Marsha Wells Blount, MD
• Scott Lee Bluck, D.O.

• Clinical Social Worker in La Mesa, CA
• Providers in La Mesa, 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 Aug 21, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.