| Jewish Family Service Of The Desert | |
|
490 S Farrell Dr Suite C 208 Palm Springs CA 92262-7992 | |
| (760) 325-4088 | |
| (760) 778-3781 |
| Full Name | Jewish Family Service Of The Desert |
|---|---|
| Speciality | Clinic/Center |
| Location | 490 S Farrell Dr, Palm Springs, California |
| Authorized Official Name and Position | Kraig Johnson (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7603254088 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jewish Family Service Of The Desert 490 S Farrell Dr Suite C 208 Palm Springs CA 92262-7992 Ph: (760) 325-4088 | Jewish Family Service Of The Desert 490 S Farrell Dr Suite C 208 Palm Springs CA 92262-7992 Ph: (760) 325-4088 |
| NPI Number | 1598758179 |
|---|---|
| Provider Enumeration Date | 08/29/2005 |
| Last Update Date | 08/11/2020 |
| Certification Date | 08/11/2020 |
| Medicare PECOS PAC ID | 3870532997 |
|---|---|
| Medicare Enrollment ID | O20050428000321 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598758179 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | James E Maloney |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053409870 PECOS PAC ID: 0547304339 Enrollment ID: I20100217000332 |
| Provider Name | Maureen H Forman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023395514 PECOS PAC ID: 7113189168 Enrollment ID: I20120508000710 |
| Provider Name | Timothy Moore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508121302 PECOS PAC ID: 5890943245 Enrollment ID: I20120911000044 |
| Provider Name | Christina A Baisden |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942503073 PECOS PAC ID: 1759606171 Enrollment ID: I20150205002534 |
| Provider Name | Diane Lavely |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619079746 PECOS PAC ID: 6709161367 Enrollment ID: I20170321002762 |
| Provider Name | Gina M Vaughn Williams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710020490 PECOS PAC ID: 5294000287 Enrollment ID: I20170929003445 |
| Provider Name | Michelle M Redman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437659992 PECOS PAC ID: 8123381092 Enrollment ID: I20180425002593 |
| Provider Name | Miranda Dianne Duncan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669863767 PECOS PAC ID: 0345575312 Enrollment ID: I20190712001320 |
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