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General NPI Number Information
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NPI Number | 1336968437
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Entity Type | Individual
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Provider Name | THANYA BEVERLY ACOSTA
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Gender | Female
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Dates
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Enumeration Date | 10/07/2024
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 12440 FIRESTONE BLVD STE 3001
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City | NORWALK
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State | CA
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Zip | 90650-4300
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Country | US
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Telephone | 562-450-0620
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Fax |
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Provider Business Mailing Address
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Address Line | 2017 LOMITA BLVD # 2251
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City | LOMITA
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State | CA
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Zip | 90717-1701
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Country | US
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Telephone | 323-999-1326
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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 | 60096
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License Number State | CA
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