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General NPI Number Information
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NPI Number | 1205314465
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Entity Type | Organization
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Legal Business Name | W.I.S.E. GROUP
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Dates
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Enumeration Date | 07/31/2018
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Last Update Date | 07/31/2018
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Provider Practice Location Address
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Address Line | 12340 SANTA MONICA BLVD STE 307
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City | LOS ANGELES
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State | CA
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Zip | 90025-0348
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Country | US
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Telephone | 310-993-6303
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 64903
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City | LOS ANGELES
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State | CA
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Zip | 90064-0903
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Country | US
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Telephone | 310-993-6303
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DEBORAH GALLIGANI
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Credential | LCSW
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Telephone | 310-993-6303
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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 | LCS23842
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License Number State | CA
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