| My Deliverance Is Freedom Licensed Clinical Social Worker, Inc | |
|
16041 Kamana Rd Ste A Apple Valley CA 92307-1331 | |
| (760) 552-9556 | |
| Not Available |
| Full Name | My Deliverance Is Freedom Licensed Clinical Social Worker, Inc |
|---|---|
| Speciality | Social Worker |
| Location | 16041 Kamana Rd Ste A, Apple Valley, California |
| Authorized Official Name and Position | Myra Dina Lopez (OWNER/CEO) |
| Authorized Official Contact | 7605529556 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| My Deliverance Is Freedom Licensed Clinical Social Worker, Inc 16041 Kamana Rd Ste A Apple Valley CA 92307-1331 Ph: (760) 552-9556 | My Deliverance Is Freedom Licensed Clinical Social Worker, Inc 16041 Kamana Rd Ste A Apple Valley CA 92307-1331 Ph: (760) 552-9556 |
| NPI Number | 1427712835 |
|---|---|
| Provider Enumeration Date | 10/22/2021 |
| Last Update Date | 06/23/2022 |
| Certification Date | 06/16/2022 |
| Medicare PECOS PAC ID | 9335522598 |
|---|---|
| Medicare Enrollment ID | O20220821000120 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427712835 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Myra Dina Lopez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023572583 PECOS PAC ID: 5193125706 Enrollment ID: I20210617002280 |
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