Healthcare Provider Details

I. General information

NPI: 1003463258
Provider Name (Legal Business Name): STUDIO CITY CLINICAL ASSOCIATES A LICENSED CLINICAL SOCIAL WORKER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 05/18/2020
Certification Date: 05/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11712 MOORPARK ST STE 205B
STUDIO CITY CA
91604-2158
US

IV. Provider business mailing address

11712 MOORPARK ST STE 205B
STUDIO CITY CA
91604-2158
US

V. Phone/Fax

Practice location:
  • Phone: 818-425-9982
  • Fax:
Mailing address:
  • Phone: 818-425-9982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. KAREN F CHAMBRE
Title or Position: PRESIDENT
Credential: LCSW
Phone: 818-425-9925