Healthcare Provider Details

I. General information

NPI: 1083999429
Provider Name (Legal Business Name): NANCY LOUISE RONNE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2011
Last Update Date: 10/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11633 SAN VICENTE BLVD STE 240
LOS ANGELES CA
90049-6513
US

IV. Provider business mailing address

11633 SAN VICENTE BLVD STE 240
LOS ANGELES CA
90049-6513
US

V. Phone/Fax

Practice location:
  • Phone: 310-242-0031
  • Fax:
Mailing address:
  • Phone: 310-242-0031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberLCS 15292
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW 15292
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: