Healthcare Provider Details

I. General information

NPI: 1134769425
Provider Name (Legal Business Name): YEHUDAH PRYCE DSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2020
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5675 W OLYMPIC BLVD
LOS ANGELES CA
90036-4712
US

IV. Provider business mailing address

5675 W OLYMPIC BLVD
LOS ANGELES CA
90036-4712
US

V. Phone/Fax

Practice location:
  • Phone: 323-965-1365
  • Fax:
Mailing address:
  • Phone: 323-965-1365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number126620
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: