Healthcare Provider Details

I. General information

NPI: 1619004033
Provider Name (Legal Business Name): CAROLYN OKAZAKI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15720 VENTURA BLVD SUITE 207
ENCINO CA
91436-2914
US

IV. Provider business mailing address

15720 VENTURA BLVD SUITE 207
ENCINO CA
91436-2914
US

V. Phone/Fax

Practice location:
  • Phone: 818-981-8905
  • Fax:
Mailing address:
  • Phone: 818-981-8905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS6783
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: