Healthcare Provider Details

I. General information

NPI: 1407296437
Provider Name (Legal Business Name): GEOFF MILAM LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2013
Last Update Date: 07/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 N FAIR OAKS AVE
PASADENA CA
91103-1620
US

IV. Provider business mailing address

1136 LOGAN ST APT 6
LOS ANGELES CA
90026-3893
US

V. Phone/Fax

Practice location:
  • Phone: 626-744-6334
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 25912
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: