Healthcare Provider Details

I. General information

NPI: 1881210722
Provider Name (Legal Business Name): H C DAVOODZADEH LICENSED CLINICAL SOCIAL WORKER INC A PROFESSIONAL C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 CAROLYN DR
PALMDALE CA
93551-5427
US

IV. Provider business mailing address

2233 CAROLYN DR
PALMDALE CA
93551-5427
US

V. Phone/Fax

Practice location:
  • Phone: 661-733-9935
  • Fax:
Mailing address:
  • Phone: 661-733-9935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. HANNA C DAVOODZADEH
Title or Position: CLINICIAN/CEO
Credential: LCSW
Phone: 661-733-9935