Healthcare Provider Details

I. General information

NPI: 1730451840
Provider Name (Legal Business Name): RORY DUVAL-BOLENDER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURA RORY DUVAL-BOLENDER LCSW

II. Dates (important events)

Enumeration Date: 02/04/2012
Last Update Date: 08/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8665 WILSHIRE BLVD SUITE 220
BEVERLY HILLS CA
90211-2975
US

IV. Provider business mailing address

130 N CROFT AVE #3
LOS ANGELES CA
90048-3423
US

V. Phone/Fax

Practice location:
  • Phone: 323-202-3631
  • Fax:
Mailing address:
  • Phone: 323-202-3631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS24657
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: