Healthcare Provider Details

I. General information

NPI: 1922720440
Provider Name (Legal Business Name): SALLY MANSOUR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14530 SYLVAN ST
VAN NUYS CA
91411-2324
US

IV. Provider business mailing address

14530 SYLVAN ST
VAN NUYS CA
91411-2324
US

V. Phone/Fax

Practice location:
  • Phone: 818-582-8832
  • Fax: 818-582-8836
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number121558
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: