Phillip George Tardanico, LCSW 69611
NPI 1063871291ActiveIndividual· Social Worker, Clinical· Victorville, CA
Social Worker, Clinical (LCSW 69611) with Sud Specialty Group - Ca and 1 other group, practicing in Victorville, California. Enrolled in Medicare as practitioner - clinical social worker and practitioner - clinical social worker.
Overview
| NPI | 1063871291 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | LCSW 69611 |
| Sole proprietor | No |
| NPI issued | Feb 16, 2016 |
| Last updated in NPPES | Jun 4, 2024 |
| Certified by provider | Jun 4, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Social Worker, Clinical Primary | 1041C0700X | LCSW69611 | CA |
| Counselor, Addiction (Substance Use Disorder) | 101YA0400X | A01210315 | CA |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Clinical Social Worker (CA); Practitioner - Clinical Social Worker (NV) |
|---|
Education and affiliations
| Graduation year | 2001 |
|---|---|
| Medicare specialty | Clinical Social Worker |
| Telehealth | Offers telehealth |
Medical groups
- Sud Specialty Group - CaSanta Clara, CA · 568 clinicians
- Phillip Tardanico, Licensed Clinical Social Worker and Associates, PCSan Bernardino, CA · 2 clinicians
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All 81 clinical social workers in Victorville · All clinical social workers in California