Healthcare Provider Details

I. General information

NPI: 1881968436
Provider Name (Legal Business Name): NADIA ISLAM PHD, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD # 53
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

3375 S HOOVER ST STE H201
LOS ANGELES CA
90089-0116
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-2350
  • Fax:
Mailing address:
  • Phone: 213-505-2704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number24725
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: