Healthcare Provider Details

I. General information

NPI: 1528142015
Provider Name (Legal Business Name): MANDANA IGHANI WERNER L.C.S.W
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MANDANA IGHANI L.C.S.W

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19231 VICTORY BLVD SUITE 110
RESEDA CA
91335-6308
US

IV. Provider business mailing address

4819 WIGGIN ST
OAK PARK CA
91377-4848
US

V. Phone/Fax

Practice location:
  • Phone: 818-708-4500
  • Fax: 818-654-1956
Mailing address:
  • Phone: 805-279-5919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCS23253
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS23253
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: