Healthcare Provider Details

I. General information

NPI: 1821240342
Provider Name (Legal Business Name): DEZETTA BURNETT DSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9415 CULVER BLVD # 77
CULVER CITY CA
90232-2616
US

IV. Provider business mailing address

4859 W SLAUSON AVE UNIT 291
LOS ANGELES CA
90056-1290
US

V. Phone/Fax

Practice location:
  • Phone: 310-957-0838
  • Fax:
Mailing address:
  • Phone: 310-957-0838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-64299
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: