Healthcare Provider Details

I. General information

NPI: 1932297280
Provider Name (Legal Business Name): MARK MATTHEW BEFORT L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 E CESAR E CHAVEZ AVE ROYBAL MENTAL HEALTH--SECOND FLOOR
LOS ANGELES CA
90022-1209
US

IV. Provider business mailing address

4701 E CESAR E CHAVEZ AVE ROYBAL MENTAL HEALTH--SECOND FLOOR
LOS ANGELES CA
90022-1209
US

V. Phone/Fax

Practice location:
  • Phone: 323-267-3400
  • Fax: 323-260-5201
Mailing address:
  • Phone: 323-267-3400
  • Fax: 323-260-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 20807
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: