Healthcare Provider Details

I. General information

NPI: 1568063162
Provider Name (Legal Business Name): TIFFANY OHARA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2020
Last Update Date: 11/02/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8075 W 3RD ST STE 306
LOS ANGELES CA
90048-4334
US

IV. Provider business mailing address

730 N EDINBURGH AVE
WEST HOLLYWOOD CA
90046-7004
US

V. Phone/Fax

Practice location:
  • Phone: 323-642-7093
  • Fax:
Mailing address:
  • Phone: 917-701-8494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number75612
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: