Healthcare Provider Details

I. General information

NPI: 1326319617
Provider Name (Legal Business Name): MANU CHERIAN VARUGHESE ACSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1529 E PALMDALE BLVD STE 210
PALMDALE CA
93550-2029
US

IV. Provider business mailing address

1529 E PALMDALE BLVD STE 210
PALMDALE CA
93550-2029
US

V. Phone/Fax

Practice location:
  • Phone: 661-272-9996
  • Fax: 661-272-0438
Mailing address:
  • Phone: 661-272-9996
  • Fax: 661-272-0438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number30301
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: