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General NPI Number Information
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NPI Number | 1669512737
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Entity Type | Individual
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Provider Name | BRETT ALLEN MCGILLIVRAY LCSW
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Gender | Male
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5000 W SUNSET BLVD 4TH FLOOR
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City | LOS ANGELES
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State | CA
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Zip | 90027-5861
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Country | US
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Telephone | 323-669-2153
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Fax |
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Provider Business Mailing Address
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Address Line | 200 MCNEIL LN #210
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-2698
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Country | US
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Telephone | 949-338-3005
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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 | LCS 23132
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License Number State | CA
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