Provider Demographics
NPI:1245060920
Name:GREATER SAN DIEGO HEALTH - A LICENSED CLINICAL SOCIAL WORKER CORP
Entity type:Organization
Organization Name:GREATER SAN DIEGO HEALTH - A LICENSED CLINICAL SOCIAL WORKER CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-925-0599
Mailing Address - Street 1:1029 BOULDER PL
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-1957
Mailing Address - Country:US
Mailing Address - Phone:714-925-0599
Mailing Address - Fax:
Practice Address - Street 1:1928 LEUCADIA SCENIC CT
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1138
Practice Address - Country:US
Practice Address - Phone:714-925-0599
Practice Address - Fax:888-507-3987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-06
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251K00000XAgenciesPublic Health or Welfare
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health