Individual provider Active NPI

Colleen Stathatos, LCSW

  • Clinical Social Worker
  • Pasadena, CA
National Provider Identifier
1942678867
Registry record updated Feb 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW68007 Issued in CA
Practice address
482 N Rosemead Blvd
Pasadena, CA 91107-3000
Phone
(859) 801-3089
NPI assigned
Sep 9, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 24, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LCSW68007 CA Primary
Clinical Social Worker 1041C0700X 11069 LA

Addresses

Primary practice location

482 N Rosemead Blvd
Pasadena, CA 91107-3000

Mailing address

619 1/2 W Lemon Ave
Monrovia, CA 91016-2611
Phone (310) 264-6646

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
LCSW68007CAMDClinical Social Worker
11069LAMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1441756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771891200000",
    "number": "1942678867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "619 1/2 W LEMON AVE",
            "city": "MONROVIA",
            "state": "CA",
            "postal_code": "910162611",
            "telephone_number": "310-264-6646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "482 N ROSEMEAD BLVD",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911073000",
            "telephone_number": "859-801-3089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STATHATOS",
        "first_name": "COLLEEN",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-09-09",
        "last_updated": "2026-02-24",
        "certification_date": "2026-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW68007",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "LA",
            "license": "11069",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pasadena, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2026; 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.