Healthcare Provider Details

I. General information

NPI: 1053868059
Provider Name (Legal Business Name): TAMARA DE ANGELIS GRIFFIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAMARA DE ANGELIS

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 05/20/2025
Certification Date: 05/19/2025
Deactivation Date: 07/29/2021
Reactivation Date: 08/25/2021

III. Provider practice location address

6055 E WASHINGTON BLVD SUITE 900
COMMERCE CA
90040-2449
US

IV. Provider business mailing address

6055 E WASHINGTON BLVD SUITE 900
COMMERCE CA
90040-2449
US

V. Phone/Fax

Practice location:
  • Phone: 323-346-0960
  • Fax: 323-346-0966
Mailing address:
  • Phone: 323-346-0960
  • Fax: 323-346-0966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number100232
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: