Healthcare Provider Details

I. General information

NPI: 1326168113
Provider Name (Legal Business Name): TALI MARIKO WHALLEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 W 97TH ST
LOS ANGELES CA
90003-3968
US

IV. Provider business mailing address

439 W 97TH ST
LOS ANGELES CA
90003-3968
US

V. Phone/Fax

Practice location:
  • Phone: 323-754-2856
  • Fax: 818-996-9850
Mailing address:
  • Phone: 213-694-0045
  • Fax: 818-996-9850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW16179
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberASW16179
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberLCS23957
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: