Healthcare Provider Details

I. General information

NPI: 1992449490
Provider Name (Legal Business Name): SOFIA EMAMIAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 04/21/2022
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 S LONG BEACH BLVD
COMPTON CA
90221-3423
US

IV. Provider business mailing address

26 RUE CANNES
NEWPORT BEACH CA
92660-5901
US

V. Phone/Fax

Practice location:
  • Phone: 310-627-5850
  • Fax: 310-627-5855
Mailing address:
  • Phone: 949-375-4193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number18740
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: