Healthcare Provider Details

I. General information

NPI: 1801998331
Provider Name (Legal Business Name): LAURA ADELE ISRAEL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2006
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 WILSHIRE BLVD SUITE 209
SANTA MONICA CA
90403-2344
US

IV. Provider business mailing address

3201 WILSHIRE BLVD SUITE 209
SANTA MONICA CA
90403-2344
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-2905
  • Fax: 310-453-6537
Mailing address:
  • Phone: 310-829-2905
  • Fax: 310-453-6537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS3955
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: