MEDICARE: PRISCILLA DE LEON L.C.S.W.

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	101YM0800X	Mental Health Counselor	LCS26529	CA

General Provider Information

NPI Number	:	1629377247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRISCILLA DE LEON L.C.S.W.

Provider Business Mailing Address
First Line	:	3915 W 64TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90043-3620
Country	:	US
Telephone Number	:	310-280-8516
Fax Number	:

Provider Business Practice Location Address
First Line	:	3915 W 64TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90043-3620
Country	:	US
Telephone Number	:	310-280-8516
Fax Number	:

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

Provider Enumeration Date	:	03/22/2011
Last Update Date	:	11/30/2021

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Directions to “ PRISCILLA DE LEON L.C.S.W.” Practice Location

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