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General NPI Number Information
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NPI Number | 1225966542
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Entity Type | Organization
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Legal Business Name | BURNETT CLINICAL GROUP, A LICENSED CLINICAL SOCIAL WORKER CORPORATION
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Dates
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Enumeration Date | 05/08/2026
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Last Update Date | 05/08/2026
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Provider Practice Location Address
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Address Line | 4900 ANGELES VISTA BLVD
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City | VIEW PARK
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State | CA
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Zip | 90043-1737
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Country | US
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Telephone | 310-957-0838
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Fax |
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Provider Business Mailing Address
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Address Line | 4859 W SLAUSON AVE UNIT 291
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City | LOS ANGELES
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State | CA
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Zip | 90056-1290
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Country | US
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Telephone | 310-957-0838
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. DEZETTA BURNETT
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Credential | DSW, LCSW
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Telephone | 310-957-0838
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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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