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General NPI Number Information
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NPI Number | 1528871035
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Entity Type | Organization
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Legal Business Name | CEREVITY, LICENSED CLINICAL SOCIAL WORKER, P.C.
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Dates
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Enumeration Date | 01/29/2025
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 3217 CARSON ST # 319
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City | LAKEWOOD
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State | CA
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Zip | 90712-4006
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Country | US
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Telephone | 562-295-6650
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Fax |
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Provider Business Mailing Address
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Address Line | 3217 CARSON ST # 319
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City | LAKEWOOD
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State | CA
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Zip | 90712-4006
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Country | US
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Telephone | 562-418-3659
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARTHA FERNANDEZ
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Credential | LCSW
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Telephone | 562-295-6650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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