Healthcare Provider Details

I. General information

NPI: 1003730706
Provider Name (Legal Business Name): YS LICENSED CLINICAL SOCIAL WORKER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 N MARENGO AVE STE 418
PASADENA CA
91101-6117
US

IV. Provider business mailing address

461 W WOODBURY RD # 541
ALTADENA CA
91001-5407
US

V. Phone/Fax

Practice location:
  • Phone: 818-925-8623
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: YASMIN SAUDI
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 818-925-8624