Healthcare Provider Details

I. General information

NPI: 1700123171
Provider Name (Legal Business Name): SHIRAZ GEWIRZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2013
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 WESTWOOD PLZ
LOS ANGELES CA
90095-1720
US

IV. Provider business mailing address

12211 MIRANDA ST
VALLEY VILLAGE CA
91607-1720
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-9111
  • Fax:
Mailing address:
  • Phone: 310-384-4491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 23370
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: