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NPI Code Detail

MEDICARE: AUDRA JO CASABELLA MSW

MEDICARE: AUDRA JO CASABELLA MSW
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
1101YM0800XMental Health CounselorASW20787CA
21041C0700XClinical Social WorkerLCSW 26550CA

General Provider Information

NPI Number : 1588796148
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUDRA JO CASABELLA MSW
Provider Business Mailing Address
First Line : 26332 MARGARITA LN
Second Line :
City : LOMA LINDA
State : CA
Zip : 92354-6737
Country : US
Telephone Number : 626-673-2252
Fax Number :
Provider Business Practice Location Address
First Line : 8019 COMPTON AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90001-3409
Country : US
Telephone Number : 323-586-7333
Fax Number : 323-319-1998
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2007
Last Update Date : 07/01/2011

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