Healthcare Provider Details

I. General information

NPI: 1730960238
Provider Name (Legal Business Name): SIMONE GRACE SYLVESTER ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2023
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 W SUNSET BLVD STE 600
LOS ANGELES CA
90027-5863
US

IV. Provider business mailing address

325 9TH AVE # 359797
SEATTLE WA
98104-2420
US

V. Phone/Fax

Practice location:
  • Phone: 323-835-5555
  • Fax:
Mailing address:
  • Phone: 206-744-9696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1730960238
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: