Healthcare Provider Details

I. General information

NPI: 1386073765
Provider Name (Legal Business Name): ALFRED JAMES MCCLOUD LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 E 103RD ST
LOS ANGELES CA
90002-3306
US

IV. Provider business mailing address

1465 E 103RD ST
LOS ANGELES CA
90002-3306
US

V. Phone/Fax

Practice location:
  • Phone: 323-564-7911
  • Fax:
Mailing address:
  • Phone: 310-720-1548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW33376
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number104155
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: