Healthcare Provider Details

I. General information

NPI: 1609260553
Provider Name (Legal Business Name): CRAIG OGULNICK M.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 03/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S BARRINGTON AVE SUITE 312
LOS ANGELES CA
90025-5363
US

IV. Provider business mailing address

111 N HILL ST ROOM 241
LOS ANGELES CA
90012-3117
US

V. Phone/Fax

Practice location:
  • Phone: 310-433-2814
  • Fax:
Mailing address:
  • Phone: 310-433-2814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: