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General NPI Number Information
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NPI Number | 1477384626
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Entity Type | Organization
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Legal Business Name | LOOKING GLASS THERAPY A LICENSED CLINICAL SOCIAL WORKER PC
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Dates
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Enumeration Date | 08/09/2024
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Last Update Date | 09/03/2024
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Provider Practice Location Address
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Address Line | 3957 30TH ST UNIT 205
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City | SAN DIEGO
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State | CA
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Zip | 92104-3078
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Country | US
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Telephone | 858-208-0403
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Fax |
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Provider Business Mailing Address
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Address Line | 3245 UNIVERSITY AVE STE 1-267
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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 | 858-208-0403
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | LAURA MAGNO
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Credential | LCSW
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Telephone | 858-208-0403
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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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