Basic Information
Provider Information
NPI: 1356547228
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ARENSON
FirstName: PAUL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3567 CARLETON ST
Address2:  
City: SAN DIEGO
State: CA
PostalCode: 921062564
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1630 E MAIN ST
Address2:  
City: EL CAJON
State: CA
PostalCode: 920215204
CountryCode: US
TelephoneNumber: 6195635300
FaxNumber: 6195905155
Other Information
ProviderEnumerationDate: 06/26/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700XLCS 5956CAY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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