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General NPI Number Information
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NPI Number | 1568707933
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Entity Type | Individual
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Provider Name | RICHARD WALLACE TAYLOR LCSW, PPSC, M-RAS
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Gender | Male
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Dates
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Enumeration Date | 12/11/2012
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Last Update Date | 04/17/2020
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Provider Practice Location Address
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Address Line | 11401 BLOOMFIELD AVE
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City | NORWALK
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State | CA
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Zip | 90650-2015
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Country | US
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Telephone | 562-521-1804
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Fax |
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Provider Business Mailing Address
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Address Line | 1007 N SEPULVEDA BLVD # 963
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-5964
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Country | US
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Telephone | 562-706-3612
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 73232
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License Number State | CA
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