Healthcare Provider Details

I. General information

NPI: 1053662817
Provider Name (Legal Business Name): AUREEN KNAULS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S VERMONT AVE
LOS ANGELES CA
90020-1912
US

IV. Provider business mailing address

PO BOX 3211
LAKEWOOD CA
90711-3211
US

V. Phone/Fax

Practice location:
  • Phone: 626-403-4370
  • Fax:
Mailing address:
  • Phone: 408-242-3474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number83326
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: