Healthcare Provider Details

I. General information

NPI: 1053560185
Provider Name (Legal Business Name): JANISE A ESCOBAR LCSW, PPSC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2008
Last Update Date: 09/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S BEAUDRY AVE
LOS ANGELES CA
90017-1466
US

IV. Provider business mailing address

333 S. BEAUDRY
LOS ANGELES CA
90026-1466
US

V. Phone/Fax

Practice location:
  • Phone: 818-331-2444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS21118
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: