Healthcare Provider Details

I. General information

NPI: 1740307768
Provider Name (Legal Business Name): JOEL E CISNEROS MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 05/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6651A BALBOA BLVD
VAN NUYS CA
91406-5529
US

IV. Provider business mailing address

6651A BALBOA BLVD
VAN NUYS CA
91406-5529
US

V. Phone/Fax

Practice location:
  • Phone: 818-758-2300
  • Fax: 818-996-9850
Mailing address:
  • Phone: 818-758-2300
  • Fax: 818-996-9850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS27997
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: