Healthcare Provider Details

I. General information

NPI: 1194881987
Provider Name (Legal Business Name): KATTY CALLENDER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S MCDONNELL AVE
COMMERCE CA
90040-5623
US

IV. Provider business mailing address

7285 QUILL DR
DOWNEY CA
90242-2001
US

V. Phone/Fax

Practice location:
  • Phone: 323-981-4301
  • Fax:
Mailing address:
  • Phone: 562-940-8767
  • Fax: 562-803-0637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS19384
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19384
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: