Healthcare Provider Details

I. General information

NPI: 1518636570
Provider Name (Legal Business Name): EMILY SONG GELBER FRUMKIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2021
Last Update Date: 09/12/2021
Certification Date: 09/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1348 PACIFIC ST
SANTA MONICA CA
90405-1515
US

IV. Provider business mailing address

3435 OCEAN PARK BLVD # 107-18
SANTA MONICA CA
90405-3301
US

V. Phone/Fax

Practice location:
  • Phone: 808-286-5143
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW102002
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: