Healthcare Provider Details

I. General information

NPI: 1205554326
Provider Name (Legal Business Name): CHLOE ELLEN RAGUSA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHLOE ELLEN GIBSON ACSW

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W JEANETTE PL
LONG BEACH CA
90810
US

IV. Provider business mailing address

1801 W JEANETTE PL
LONG BEACH CA
90810-3008
US

V. Phone/Fax

Practice location:
  • Phone: 323-798-7413
  • Fax: 833-419-0181
Mailing address:
  • Phone: 310-213-5677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number115282
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: