Healthcare Provider Details

I. General information

NPI: 1669764593
Provider Name (Legal Business Name): LEONA SMITH DI FAUSTINO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date: 04/30/2020
Reactivation Date: 09/09/2026

III. Provider practice location address

7381 LA TIJERA BLVD UNIT 45918
LOS ANGELES CA
90045-7039
US

IV. Provider business mailing address

7381 LA TIJERA BLVD UNIT 45918
LOS ANGELES CA
90045-7039
US

V. Phone/Fax

Practice location:
  • Phone: 213-674-9272
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number26214
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: