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General NPI Number Information
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NPI Number | 1306635404
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Entity Type | Organization
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Legal Business Name | SD ZEN LICENSED CLINICAL SOCIAL WORKER PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 05/05/2025
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 8885 RIO SAN DIEGO DR STE 237
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City | SAN DIEGO
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State | CA
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Zip | 92108-1661
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Country | US
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Telephone | 619-363-1921
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Fax |
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Provider Business Mailing Address
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Address Line | 3245 UNIVERSITY AVE STE 1
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City | SAN DIEGO
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State | CA
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Zip | 92104-2009
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Country | US
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Telephone | 619-363-1921
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Fax |
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Authorized Official
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Title or Position | CLINICAL MANAGER
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Name | ALEXANDER PETRO
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Credential |
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Telephone | 818-414-4610
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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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