MEDICARE: CLYMIE ALLEN 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	LCS10310	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366579146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLYMIE ALLEN LCSW

Provider Business Mailing Address
First Line	:	5631 S LA CIENEGA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90056-1333
Country	:	US
Telephone Number	:	310-613-1962
Fax Number	:

Provider Business Practice Location Address
First Line	:	5631 S LA CIENEGA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90056-1333
Country	:	US
Telephone Number	:	310-613-1962
Fax Number	:

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

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	12/19/2019

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Directions to “ CLYMIE ALLEN LCSW” Practice Location

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