Grey Space Therapy, Lcsw Professional Corporation
NPI 1174238190ActiveOrganization· Social Worker, Clinical· Riverside, CA
Social Worker, Clinical in Riverside, California, registered in NPPES in January 2023. The authorized official on file is Fabiola Pacheco, LCSW, Founder.
Overview
| NPI | 1174238190 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jan 16, 2023 |
| Last updated in NPPES | Jan 16, 2023 |
| Certified by provider | Jan 14, 2023 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Social Worker, Clinical Primary | 1041C0700X | — | — |
| Counselor, Mental Health | 101YM0800X | — | — |
| Counselor, Professional | 101YP2500X | — | — |
| Marriage & Family Therapist | 106H00000X | — | — |
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) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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