Provider Demographics
NPI:1215084116
Name:LAKE, NAOMI BARRIE (SOCIAL WORKER)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:BARRIE
Last Name:LAKE
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:NAOMI
Other - Middle Name:
Other - Last Name:BARRIE LAKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SOCIAL WORKER
Mailing Address - Street 1:PO BOX 609001
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92160-9001
Mailing Address - Country:US
Mailing Address - Phone:619-528-4600
Mailing Address - Fax:619-528-4625
Practice Address - Street 1:5353 MISSION CENTER RD STE 224
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1304
Practice Address - Country:US
Practice Address - Phone:619-688-5855
Practice Address - Fax:619-291-3310
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS174131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWSW17413AMedicare Oscar/Certification