Healthcare Provider Details

I. General information

NPI: 1932271046
Provider Name (Legal Business Name): MARY ARCELIA BAYRAKTAR L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E OLIVE AVE STE 101
BURBANK CA
91502-1846
US

IV. Provider business mailing address

150 E OLIVE AVE STE 101
BURBANK CA
91502-1849
US

V. Phone/Fax

Practice location:
  • Phone: 818-846-6782
  • Fax: 818-846-8813
Mailing address:
  • Phone: 818-846-6782
  • Fax: 818-846-8813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCS11509
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: