Healthcare Provider Details

I. General information

NPI: 1508098484
Provider Name (Legal Business Name): LANA SELMA SMITH HALE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2009
Last Update Date: 03/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S FAIR OAKS AVE STE 315
PASADENA CA
91105-2010
US

IV. Provider business mailing address

453 S GRAND AVE
PASADENA CA
91105-1647
US

V. Phone/Fax

Practice location:
  • Phone: 626-765-7405
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number28996
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: