Healthcare Provider Details

I. General information

NPI: 1962625731
Provider Name (Legal Business Name): ILANA R COHEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ILANA R. NOMBERG LCSW

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2541 CANYON OAK DR
LOS ANGELES CA
90068-2429
US

IV. Provider business mailing address

2541 CANYON OAK DR
LOS ANGELES CA
90068-2429
US

V. Phone/Fax

Practice location:
  • Phone: 323-461-6167
  • Fax:
Mailing address:
  • Phone: 323-461-6167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22621
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: