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NPI Code Detail

MEDICARE: MS. NAN RADULOVIC LCSW

MEDICARE: MS. NAN RADULOVIC 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
11041C0700XClinical Social WorkerLCS18609CA

General Provider Information

NPI Number : 1699969451
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. NAN RADULOVIC LCSW
Provider Business Mailing Address
First Line : 2128 PICO BLVD
Second Line :
City : SANTA MONICA
State : CA
Zip : 90405-1718
Country : US
Telephone Number : 310-801-3438
Fax Number :
Provider Business Practice Location Address
First Line : 2128 PICO BLVD
Second Line :
City : SANTA MONICA
State : CA
Zip : 90405-1718
Country : US
Telephone Number : 310-801-3438
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2007
Last Update Date : 09/04/2007

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