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General NPI Number Information
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NPI Number | 1649931163
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Entity Type | Organization
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Legal Business Name | DR PRISCILLA PSY D LICENSED CLINICAL SOCIAL WORKER CORP
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Dates
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Enumeration Date | 01/06/2022
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 12915 DAPHNE AVE
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City | GARDENA
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State | CA
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Zip | 90249-1603
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Country | US
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Telephone | 951-203-1917
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Fax |
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Provider Business Mailing Address
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Address Line | 222 N PACIFIC COAST HWY STE 2000
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City | EL SEGUNDO
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State | CA
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Zip | 90245-5614
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Country | US
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Telephone | 951-203-1917
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Fax |
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Authorized Official
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Title or Position | PYSCHOTHERAPIST
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Name | PRISCILLA GALES
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Credential | LCSW
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Telephone | 951-203-1917
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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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