MEDICARE: JANICE DERDERIAN-HARBIN 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	SW7388	CA

General Provider Information

NPI Number	:	1366409625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE DERDERIAN-HARBIN LCSW

Provider Business Mailing Address
First Line	:	4481 GUAVA AVE
Second Line	:
City	:	SEAL BEACH
State	:	CA
Zip	:	90740-2937
Country	:	US
Telephone Number	:	562-714-3723
Fax Number	:

Provider Business Practice Location Address
First Line	:	4481 GUAVA AVE
Second Line	:
City	:	SEAL BEACH
State	:	CA
Zip	:	90740-2937
Country	:	US
Telephone Number	:	562-714-3723
Fax Number	:

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

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	10/29/2015

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