Healthcare Provider Details

I. General information

NPI: 1548455991
Provider Name (Legal Business Name): GARIE E CONNELL MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 09/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 DESOTO AVE.
WOODLAND HILLS CA
91405-3087
US

IV. Provider business mailing address

5601 DESOTO AVE.
WOODLAND HILLS CA
91405-3087
US

V. Phone/Fax

Practice location:
  • Phone: 818-719-7955
  • Fax:
Mailing address:
  • Phone: 818-719-7955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number28969
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberASW24116
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: