Healthcare Provider Details

I. General information

NPI: 1346448610
Provider Name (Legal Business Name): NATALIE DIANE DEMUS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 E UNIVERSITY DR # B188
CARSON CA
90746-1969
US

IV. Provider business mailing address

603 E UNIVERSITY DR # B188
CARSON CA
90746-1969
US

V. Phone/Fax

Practice location:
  • Phone: 310-645-1081
  • Fax:
Mailing address:
  • Phone: 310-645-1081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS17351
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: