Healthcare Provider Details

I. General information

NPI: 1457559304
Provider Name (Legal Business Name): RAPHAEL C NJOKU LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 11/26/2021
Certification Date: 11/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2081 PALOS VERDES DR N
LOMITA CA
90717-3701
US

IV. Provider business mailing address

393 E WALNUT ST 3RD FLOOR - PHR SYSTEMS
PASADENA CA
91188-0001
US

V. Phone/Fax

Practice location:
  • Phone: 310-534-6011
  • Fax:
Mailing address:
  • Phone: 626-405-7914
  • Fax: 626-405-6768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS22657
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: