Healthcare Provider Details

I. General information

NPI: 1366357394
Provider Name (Legal Business Name): CAL BRISBIN ASW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4789 VINELAND AVE STE 205
NORTH HOLLYWOOD CA
91602-3518
US

IV. Provider business mailing address

4789 VINELAND AVE STE 205
NORTH HOLLYWOOD CA
91602-3518
US

V. Phone/Fax

Practice location:
  • Phone: 818-770-6147
  • Fax: 213-232-1008
Mailing address:
  • Phone: 818-770-6147
  • Fax: 213-232-1008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW114562
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: