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General NPI Number Information
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NPI Number | 1396613428
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Entity Type | Organization
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Legal Business Name | LKG LICENSED CLINICAL SOCIAL WORKER INC
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Dates
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Enumeration Date | 10/29/2025
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 10780 SANTA MONICA BLVD STE 105
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City | LOS ANGELES
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State | CA
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Zip | 90025-7613
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Country | US
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Telephone | 323-456-3864
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Fax |
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Provider Business Mailing Address
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Address Line | 3019 OCEAN PARK BLVD # 805
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City | SANTA MONICA
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State | CA
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Zip | 90405-3004
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Country | US
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Telephone | 323-456-3864
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAUDAN KERMANI GISH
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Credential | LCSW
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Telephone | 323-456-3864
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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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