Provider Demographics
NPI:1285441568
Name:OPTIMIZE EMOTIONAL INTELLIGENCE CLINICAL SOCIAL WORKER, INC.
Entity type:Organization
Organization Name:OPTIMIZE EMOTIONAL INTELLIGENCE CLINICAL SOCIAL WORKER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:LISETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:951-999-7298
Mailing Address - Street 1:6809 INDIANA AVE STE 170
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-4221
Mailing Address - Country:US
Mailing Address - Phone:951-999-7298
Mailing Address - Fax:
Practice Address - Street 1:6809 INDIANA AVE STE 170
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4221
Practice Address - Country:US
Practice Address - Phone:951-999-7298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-11
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty