Healthcare Provider Details

I. General information

NPI: 1619412178
Provider Name (Legal Business Name): CODY HANABLE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 8620
PASADENA CA
91109-8608
US

IV. Provider business mailing address

PO BOX 8620
PASADENA CA
91109-8608
US

V. Phone/Fax

Practice location:
  • Phone: 626-499-5687
  • Fax:
Mailing address:
  • Phone: 626-499-5687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW71423
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW71423
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW137760
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW108644
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW108644
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: