Healthcare Provider Details

I. General information

NPI: 1417106980
Provider Name (Legal Business Name): BLESSY GIRON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 08/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13666 HAWTHORNE BLVD STE 3
HAWTHORNE CA
90250-5815
US

IV. Provider business mailing address

13666 HAWTHORNE BLVD STE 3
HAWTHORNE CA
90250-5815
US

V. Phone/Fax

Practice location:
  • Phone: 213-448-6605
  • Fax: 424-456-7442
Mailing address:
  • Phone: 213-448-6605
  • Fax: 424-456-7442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS28675
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: