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General NPI Number Information
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NPI Number | 1265610901
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Entity Type | Individual
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Provider Name | CHARM HEDEMARK LCSW 27089
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Gender | Female
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Dates
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Enumeration Date | 02/05/2008
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Last Update Date | 11/06/2023
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Provider Practice Location Address
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Address Line | 851 N OAKLAND AVE
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City | PASADENA
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State | CA
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Zip | 91104-4343
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Country | US
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Telephone | 626-395-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 11 S KNOLL RD APT 20
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City | MILL VALLEY
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State | CA
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Zip | 94941-2453
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Country | US
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Telephone | 323-632-4300
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | LCSW27089
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License Number State | CA
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