Healthcare Provider Details

I. General information

NPI: 1174640312
Provider Name (Legal Business Name): ANGELICA ISAAC PALMA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S VERMONT AVE FL 10
LOS ANGELES CA
90020-1912
US

IV. Provider business mailing address

4740 N GRAND AVE
COVINA CA
91724-2005
US

V. Phone/Fax

Practice location:
  • Phone: 626-258-3059
  • Fax: 626-258-3020
Mailing address:
  • Phone: 626-859-2089
  • Fax: 626-859-6537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW 15220
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number26539
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: