Healthcare Provider Details

I. General information

NPI: 1598043150
Provider Name (Legal Business Name): PHILIP URBINA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 1ST ST STE 100
SAN FERNANDO CA
91340-2957
US

IV. Provider business mailing address

10605 BALBOA BLVD SUITE 100
GRANADA HILLS CA
91344-6342
US

V. Phone/Fax

Practice location:
  • Phone: 818-256-1124
  • Fax:
Mailing address:
  • Phone: 818-832-2400
  • Fax: 818-832-2567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW99344
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: