Healthcare Provider Details

I. General information

NPI: 1225966542
Provider Name (Legal Business Name): BURNETT CLINICAL GROUP, A LICENSED CLINICAL SOCIAL WORKER CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 ANGELES VISTA BLVD
VIEW PARK CA
90043-1737
US

IV. Provider business mailing address

4859 W SLAUSON AVE UNIT 291
LOS ANGELES CA
90056-1290
US

V. Phone/Fax

Practice location:
  • Phone: 310-957-0838
  • Fax:
Mailing address:
  • Phone: 310-957-0838
  • 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: DR. DEZETTA BURNETT
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: DSW, LCSW
Phone: 310-957-0838