Healthcare Provider Details

I. General information

NPI: 1619096740
Provider Name (Legal Business Name): LORETTA WHITE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 AVALON BLVD
LOS ANGELES CA
90011-5622
US

IV. Provider business mailing address

985 E 55TH ST
LOS ANGELES CA
90011-5209
US

V. Phone/Fax

Practice location:
  • Phone: 323-432-5185
  • Fax: 323-432-5086
Mailing address:
  • Phone: 323-234-7859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number34462
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW127537
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: