MEDICARE: EMILY ARDELJAN 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	101YM0800X	Mental Health Counselor	83124	CA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	1041C0700X	Clinical Social Worker	101109	CA

General Provider Information

NPI Number	:	1972030229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY ARDELJAN LCSW

Provider Business Mailing Address
First Line	:	1755 N BERENDO ST APT 3
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-4161
Country	:	US
Telephone Number	:	310-489-4331
Fax Number	:

Provider Business Practice Location Address
First Line	:	1755 N BERENDO ST APT 3
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-4161
Country	:	US
Telephone Number	:	323-524-3103
Fax Number	:

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

Provider Enumeration Date	:	05/17/2017
Last Update Date	:	04/06/2022

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