Provider Demographics
NPI:1669428157
Name:MCCREREY, RITA K (LCSW)
Entity type:Individual
Prefix:MS
First Name:RITA
Middle Name:K
Last Name:MCCREREY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:RITA
Other - Middle Name:K
Other - Last Name:MCCREREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5575 LAKE PARK WAY STE 114
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-1674
Mailing Address - Country:US
Mailing Address - Phone:619-922-6059
Mailing Address - Fax:619-463-8986
Practice Address - Street 1:5575 LAKE PARK WAY STE 114
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-1674
Practice Address - Country:US
Practice Address - Phone:619-922-6059
Practice Address - Fax:619-463-8986
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS128801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW416Medicare PIN
CAWSW12880AMedicare PIN