Healthcare Provider Details

I. General information

NPI: 1972369809
Provider Name (Legal Business Name): ANDREW NICHOLAS DENNETT LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2024
Last Update Date: 01/18/2026
Certification Date: 01/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9777 WILSHIRE BLVD STE 1007
BEVERLY HILLS CA
90212-1901
US

IV. Provider business mailing address

2355 WESTWOOD BLVD # 1128
LOS ANGELES CA
90064-2109
US

V. Phone/Fax

Practice location:
  • Phone: 310-461-4148
  • Fax:
Mailing address:
  • Phone: 310-356-9544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number136239
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: