Healthcare Provider Details

I. General information

NPI: 1558778845
Provider Name (Legal Business Name): ANDREA R ANZUETO ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2014
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12021 WILMINGTON AVE FL 2
LOS ANGELES CA
90059-3019
US

IV. Provider business mailing address

20151 NORDHOFF ST
CHATSWORTH CA
91311-6215
US

V. Phone/Fax

Practice location:
  • Phone: 424-454-5000
  • Fax: 424-337-4037
Mailing address:
  • Phone: 818-407-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number90057
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW90057
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: