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General NPI Number Information
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NPI Number | 1457072381
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Entity Type | Organization
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Legal Business Name | A WHOLE NEW YOU, LICENSED CLINICAL SOCIAL WORKER, INC
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Dates
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Enumeration Date | 09/08/2022
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Last Update Date | 09/13/2022
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Provider Practice Location Address
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Address Line | 150 N GRAND AVE STE 212
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City | WEST COVINA
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State | CA
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Zip | 91791-1757
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Country | US
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Telephone | 626-267-2579
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Fax |
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Provider Business Mailing Address
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Address Line | 170 E COLLEGE ST UNIT 204
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City | COVINA
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State | CA
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Zip | 91723-7008
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Country | US
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Telephone | 626-267-2579
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LYNN GONZALEZ
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Credential | LCSW
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Telephone | 626-267-2579
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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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