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General NPI Number Information
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NPI Number | 1457840258
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Entity Type | Organization
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Legal Business Name | HEALING BLUE INC A LICENSED CLINICAL SOCIAL WORKER COPORATION
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Dates
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Enumeration Date | 05/07/2018
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Last Update Date | 03/16/2023
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Provider Practice Location Address
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Address Line | 10315 WOODLEY AVE STE 215
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City | GRANADA HILLS
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State | CA
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Zip | 91344-6950
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Country | US
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Telephone | 818-945-9075
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Fax |
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Provider Business Mailing Address
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Address Line | 16001 HORACE ST
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City | GRANADA HILLS
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State | CA
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Zip | 91344-5322
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Country | US
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Telephone | 323-351-3633
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARIA MARTINEZ
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Credential | LCSW
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Telephone | 323-351-3633
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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 | LCSW80703
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License Number State | CA
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