Provider Demographics
NPI:1194504480
Name:CLINICAL SOCIAL WORK CORPORATION OF CALIFRONIA
Entity type:Organization
Organization Name:CLINICAL SOCIAL WORK CORPORATION OF CALIFRONIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:G
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LISW CP & AP
Authorized Official - Phone:803-331-0865
Mailing Address - Street 1:4712 ADMIRALTY WAY # 1011
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6905
Mailing Address - Country:US
Mailing Address - Phone:909-515-3698
Mailing Address - Fax:
Practice Address - Street 1:13902 FIJI WAY APT 119
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6922
Practice Address - Country:US
Practice Address - Phone:909-515-3698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management