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General NPI Number Information
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NPI Number | 1104454966
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Entity Type | Organization
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Legal Business Name | TTM LICENSED CLINICAL SOCIAL WORKER INC.
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Dates
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Enumeration Date | 03/29/2020
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Last Update Date | 03/29/2020
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Provider Practice Location Address
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Address Line | 16133 VENTURA BLVD STE 1125
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City | ENCINO
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State | CA
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Zip | 91436-2424
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Country | US
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Telephone | 818-522-6212
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Fax |
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Provider Business Mailing Address
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Address Line | 19360 RINALDI ST # 141
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City | PORTER RANCH
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State | CA
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Zip | 91326-1607
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Country | US
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Telephone | 310-490-1968
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/ CEO
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Name | TATIANA MELENDEZ
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Credential | MA, MSW, LCSW
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Telephone | 310-490-1968
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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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