Healthcare Provider Details

I. General information

NPI: 1295874915
Provider Name (Legal Business Name): SEANA AYLEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4091 RIVERSIDE DR
CHINO CA
91710-6501
US

IV. Provider business mailing address

5675 TELEGRAPH RD STE 260
COMMERCE CA
90040-1570
US

V. Phone/Fax

Practice location:
  • Phone: 909-717-4574
  • Fax:
Mailing address:
  • Phone: 323-838-9566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number26248
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: