Mrs Krystal Marie Boothe, LCSW | |
1050 Lakes Dr, West Covina, CA 91790-2924 | |
(310) 621-0150 | |
(661) 727-0006 |
Full Name | Mrs Krystal Marie Boothe |
---|---|
Gender | Female |
Speciality | Social Worker - Clinical |
Location | 1050 Lakes Dr, West Covina, California |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1043488414 | NPI | - | NPPES |
99999999999999 | Medicaid | CA | |
9999999999 | Other | CA | BLUE CROSS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1041C0700X | Social Worker - Clinical | LCSW71811 (California) | Primary |
Entity Name | Wings Of The Future Private Practice Lcsw Pc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1144705724 PECOS PAC ID: 8729488440 Enrollment ID: O20220223000697 |
Mailing Address | Practice Location Address |
---|---|
Mrs Krystal Marie Boothe, LCSW 418 N Dalton Ave, Azusa, CA 91702-3634 Ph: (310) 621-0150 | Mrs Krystal Marie Boothe, LCSW 1050 Lakes Dr, West Covina, CA 91790-2924 Ph: (310) 621-0150 |
Naleah Hamilton, Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 1050 Lakes Dr Ste 225, West Covina, CA 91790 Phone: 661-402-1545 | |
Serena Maria Avilez, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 703 S Terri Ann Dr, West Covina, CA 91791 Phone: 626-826-9670 | |
Ruiqi He, ACSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 1515 W Cameron Ave Ste 218, West Covina, CA 91790 Phone: 626-653-9913 | |
Alysha Mccuistion, Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 1215 W West Covina Pkwy, Suite 200, West Covina, CA 91790 Phone: 626-338-9200 | |
Ms. Elizabeth Mendez, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 2934 E Garvey Ave S, West Covina, CA 91791 Phone: 626-390-8664 | |
Beth Anne Grant, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 1115 S Sunset Ave, West Covina, CA 91790 Phone: 626-851-2788 |