Active NPI
Tara Agajanian, LCSW
- Clinical Social Worker
- Corona, CA
National Provider Identifier
1962100420
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 113641
- Practice address
- 3142 Pinehurst Dr
Corona, CA 92881-0928 - Phone
- (951) 265-3273
- NPI assigned
- Feb 23, 2023
- Last updated
- Feb 23, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 113641 | CA | Primary |
Addresses
Primary practice location
3142 Pinehurst Dr
Corona, CA 92881-0928
Mailing address
3142 Pinehurst Dr
Corona, CA 92881-0928
Phone (951) 265-3273
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
| License | State | Type | Specialty |
|---|---|---|---|
| 113641 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1677110400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1677110400000",
"number": "1962100420",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3142 PINEHURST DR",
"city": "CORONA",
"state": "CA",
"postal_code": "928810928",
"telephone_number": "951-265-3273"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3142 PINEHURST DR",
"city": "CORONA",
"state": "CA",
"postal_code": "928810928",
"telephone_number": "951-265-3273"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AGAJANIAN",
"first_name": "TARA",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-02-23",
"last_updated": "2023-02-23",
"certification_date": "2023-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "113641",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corona, CA
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- Afra Dental Group, Apc
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- Agape Group, Inc (Caring Angels Hospice)
- Obi Etengeneng Agbor, LVN
- Theophilus Agbor Agbor, REGISTERED NURSE
- Elizabeth Rose Agramonte
- Amy Lee Aguilar
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.