Social Services of Southern California a Licensed Clinical Social Work

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW74489 Issued in CA

Legal business name

SOCIAL SERVICES OF SOUTHERN CALIFORNIA A LICENSED CLINICAL SOCIAL WORK

Doing business as

Your Space Counseling

Practice address

78150 Calle Tampico Ste 200C
La Quinta, CA 92253-7406

Phone

(760) 364-8229

NPI assigned

Jan 28, 2018

Last updated

Jan 28, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Angelica Paola Beltran, LCSW

Title

Manager

Phone

(760) 364-8229

Specialties & licenses 1

Addresses

Other names 1

• Your Space Counseling Doing business as

Locations

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

{
    "created_epoch": "1517097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517097600000",
    "number": "1912405630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "78150 CALLE TAMPICO STE 200C",
            "city": "LA QUINTA",
            "state": "CA",
            "postal_code": "922537406",
            "telephone_number": "760-364-8229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "78150 CALLE TAMPICO STE 200C",
            "city": "LA QUINTA",
            "state": "CA",
            "postal_code": "922537406",
            "telephone_number": "760-364-8229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOCIAL SERVICES OF SOUTHERN CALIFORNIA A LICENSED CLINICAL SOCIAL WORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-28",
        "last_updated": "2018-01-28",
        "status": "A",
        "authorized_official_last_name": "BELTRAN",
        "authorized_official_first_name": "ANGELICA",
        "authorized_official_middle_name": "PAOLA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "760-364-8229",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW74489",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Your Space Counseling",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sophai Simok
• Trishta Siqueiros-Villalta
• Robert Siskin
• Jason Matthew Smith, PTA
• Karen Renee Snake
• Delos Soehren Jr., D.C.
• Rita Soto, DDA
• Nash Sourial, D.D.S.
• Kari Elizabeth Sower, NP
• Balachandran Dobli Srinivasan, MD, MD

• Clinical Social Worker in La Quinta, CA
• Providers in La Quinta, 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 Jan 28, 2018; 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.