Healthcare Provider Details

I. General information

NPI: 1366959595
Provider Name (Legal Business Name): DAVID HIGHFILL LCSW, MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 S MARENGO AVE
PASADENA CA
91101-3113
US

IV. Provider business mailing address

444 S MARENGO AVE
PASADENA CA
91101-3113
US

V. Phone/Fax

Practice location:
  • Phone: 626-782-5279
  • Fax: 866-379-8010
Mailing address:
  • Phone: 626-782-5279
  • Fax: 866-379-8010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21642
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: