Healthcare Provider Details

I. General information

NPI: 1598190951
Provider Name (Legal Business Name): CHARLES RAY COCHRAN JR. LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2812 AVENEL STREET
LOS ANGELES CA
90039-2047
US

IV. Provider business mailing address

2436 HIDALGO AVENUE
LOS ANGELES CA
90039-3306
US

V. Phone/Fax

Practice location:
  • Phone: 323-627-7020
  • Fax:
Mailing address:
  • Phone: 323-627-7020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number81770LCSW
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number81770
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: