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General NPI Number Information
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NPI Number | 1033878111
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Entity Type | Organization
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Legal Business Name | PATH TO HEALING
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Dates
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Enumeration Date | 12/15/2021
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Last Update Date | 12/15/2021
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Provider Practice Location Address
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Address Line | 5250 LINDLEY AVE
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City | ENCINO
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State | CA
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Zip | 91316-3518
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Country | US
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Telephone | 718-938-0949
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Fax | 818-960-0038
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Provider Business Mailing Address
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Address Line | 5250 LINDLEY AVE
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City | ENCINO
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State | CA
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Zip | 91316-3518
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Country | US
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Telephone | 718-938-0949
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Fax | 818-960-0038
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Authorized Official
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Title or Position | OWNER
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Name | MRS. FIANA KOSHEVATSKY
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Credential | LCSW
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Telephone | 718-938-0949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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