TAKENYA CHIMENE CLARK-JEFFERIES LCSW
NPI 1205087657
Social Worker in Grand Terrace, CA

Active since October 03, 2008PECOS Enrolled
12139 MOUNT VERNON AVE STE 104, GRAND TERRACE, CA 92313(909) 452-5857(909) 527-4811 Get Directions Write a Review

NPPES record last updated: August 22, 2023. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Aug 22, 2023, Jan 29, 2021, Sep 11, 2018 (3 updates tracked since 2018).

About Takenya Chimene Clark-jefferies Lcsw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TAKENYA CHIMENE CLARK-JEFFERIES LCSW (NPI 1205087657) is an individual social worker in Grand Terrace, California, licensed in California (LCS#62241) and active in the NPI registry since October 2008. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1205087657
Entity TypeIndividualFemale
Primary Taxonomy104100000X
Provider Legal NameTAKENYA CHIMENE CLARK-JEFFERIESCredential: LCSW
Location Address12139 MOUNT VERNON AVE STE 104Grand Terrace, CA 92313-5500
Mailing AddressPo Box 1361Bloomington, CA 92316-0380 · (909) 452-5857 · Fax (909) 527-4813
Fax(909) 527-4811
Sole ProprietorYes
Enumeration DateOctober 3, 2008
Last NPPES UpdateAugust 22, 20233 updates tracked since enumeration
NPPES CertifiedAugust 22, 2023
NPI 1205087657 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySocial WorkerBehavioral Health & Social Service Providers
Taxonomy Code104100000X
License Licensed in CA · LCS#62241
Definition

A social worker is a person who is qualified by a Social Work degree, and licensed, certified or registered by the state as a social worker to practice within the scope of that license. A social worker provides assistance and counseling to clients and their families who are dealing with social, emotional and environmental problems. Social work services may be rendered to individuals, families, groups, and the public.

12139 MOUNT VERNON AVE STE 104, Grand Terrace, CA 92313

Other Names 1

Professional Name (2)Takenya Chimene Clark Msw

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare (PECOS)

Takenya Chimene Clark-jefferies Lcsw is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Community/Behavioral Health
12139 MOUNT VERNON AVE STE 104
GRAND TERRACE, CA 92313

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1205087657, enumerated as an "individual" on October 03, 2008.

The provider is located at 12139 MOUNT VERNON AVE STE 104 GRAND TERRACE, CA 92313 and the phone number is (909) 452-5857.

Social Worker with taxonomy code 104100000X.