Healthcare Provider Details

I. General information

NPI: 1013297266
Provider Name (Legal Business Name): CLAUDIA JOAN ROSA-BIENENFELD, MSW LICENSED CLINICAL SOCIAL WORKER, A P
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2011
Last Update Date: 07/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11911 SAN VICENTE BLVD SUITE 280
LOS ANGELES CA
90049-5086
US

IV. Provider business mailing address

10153 1/2 RIVERSIDE DRIVE, SUITE 198
TOLUCA LAKE CA
91602-2561
US

V. Phone/Fax

Practice location:
  • Phone: 818-487-2593
  • Fax:
Mailing address:
  • Phone:
  • Fax: 818-487-8591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLCS19209
License Number StateCA

VIII. Authorized Official

Name: CLAUDIA JOAN ROSA-BIENENFELD
Title or Position: CEO
Credential: MSW, LCSW
Phone: 818-487-2593