Healthcare Provider Details

I. General information

NPI: 1174682512
Provider Name (Legal Business Name): HENRY JOSEPH PARIS SR. MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 E 1ST ST SUITE 100
SANTA ANA CA
92701-6384
US

IV. Provider business mailing address

1215 MC FADDEN DR
FULLERTON CA
92833-5603
US

V. Phone/Fax

Practice location:
  • Phone: 714-953-4455
  • Fax: 714-542-2793
Mailing address:
  • Phone: 714-953-4455
  • Fax: 714-542-2793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCW 432
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: