MEDICARE: COGNITIVE CONNECTIONS PLUS

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

General Provider Information

NPI Number	:	1336999754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COGNITIVE CONNECTIONS PLUS

Provider Business Mailing Address
First Line	:	12553 KILLION ST
Second Line	:
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-1533
Country	:	US
Telephone Number	:	424-333-0141
Fax Number	:

Provider Business Practice Location Address
First Line	:	12553 KILLION ST
Second Line	:
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-1533
Country	:	US
Telephone Number	:	424-333-0141
Fax Number	:

Authorized Official
Title or Position	:	OWNER, LICENSED CLINICAL SOCIAL WOR
Name	:	MRS. SANDRA NOWOSIOLSKI
Credential	:	LCSW
Telephone Number	:	424-333-0141

Provider Enumeration Date	:	03/26/2024
Last Update Date	:	03/26/2024

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