Provider Demographics
NPI:1750157871
Name:DARLENE TANDO LICENSED CLINICAL SOCIAL WORKER APC
Entity type:Organization
Organization Name:DARLENE TANDO LICENSED CLINICAL SOCIAL WORKER APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:TANDO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:619-948-8926
Mailing Address - Street 1:3245 UNIVERSITY AVE STE 1
Mailing Address - Street 2:#357
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-2009
Mailing Address - Country:US
Mailing Address - Phone:619-948-8926
Mailing Address - Fax:
Practice Address - Street 1:3202 3RD AVE
Practice Address - Street 2:# 2
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103
Practice Address - Country:US
Practice Address - Phone:619-948-8926
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)