MEDICARE: MR. TODD LUCAS PERLMUTTER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCS17123	CA

General Provider Information

NPI Number	:	1033281944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TODD LUCAS PERLMUTTER LCSW

Provider Business Mailing Address
First Line	:	5737 KANAN ROAD
Second Line	:	285
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5737 KANAN RD
Second Line	:	285
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-1601
Country	:	US
Telephone Number	:	818-597-0115
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	06/11/2019

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