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NPI Code Detail

MEDICARE: LAURA FAE SGRO LCSW

MEDICARE: LAURA FAE SGRO 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
1104100000XSocial WorkerASW86023CA
21041C0700XClinical Social WorkerLCSW100705CA

General Provider Information

NPI Number : 1700387057
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA FAE SGRO LCSW
Provider Business Mailing Address
First Line : 601 S GLENOAKS BLVD STE 200
Second Line :
City : BURBANK
State : CA
Zip : 91502-2787
Country : US
Telephone Number : 818-940-3386
Fax Number :
Provider Business Practice Location Address
First Line : 601 S GLENOAKS BLVD STE 200
Second Line :
City : BURBANK
State : CA
Zip : 91502-2787
Country : US
Telephone Number : 818-940-3386
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2018
Last Update Date : 03/31/2021

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Directions to “ LAURA FAE SGRO LCSW” Practice Location

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