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NPI Code Detail

MEDICARE: KERESTIAN ESTEDABADI LCSW

MEDICARE: KERESTIAN ESTEDABADI 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
11041C0700XClinical Social Worker88085CA

General Provider Information

NPI Number : 1265006126
Entity Type Code : Individual
Provider Name (Legal Business Name) : KERESTIAN ESTEDABADI LCSW
Provider Business Mailing Address
First Line : 7843 LANKERSHIM BLVD
Second Line :
City : NORTH HOLLYWOOD
State : CA
Zip : 91605-2523
Country : US
Telephone Number : 818-932-8178
Fax Number :
Provider Business Practice Location Address
First Line : 7843 LANKERSHIM BLVD
Second Line :
City : NORTH HOLLYWOOD
State : CA
Zip : 91605-2523
Country : US
Telephone Number : 818-932-8178
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2021
Last Update Date : 05/16/2021

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Directions to “ KERESTIAN ESTEDABADI LCSW” Practice Location

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