Healthcare Provider Details

I. General information

NPI: 1255667374
Provider Name (Legal Business Name): OLIVIA PHUONG-PHAM LY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: OLIVIA PHUONG PHAM LCSW

II. Dates (important events)

Enumeration Date: 10/23/2009
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W CIVIC CENTER DR
SANTA ANA CA
92701-4515
US

IV. Provider business mailing address

35 SORBONNE ST
WESTMINSTER CA
92683-8916
US

V. Phone/Fax

Practice location:
  • Phone: 714-480-6642
  • Fax: 714-850-8455
Mailing address:
  • Phone: 714-880-4476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW70123
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: