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General NPI Number Information
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NPI Number | 1700387057
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Entity Type | Individual
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Provider Name | LAURA FAE SGRO LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/22/2018
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Last Update Date | 03/31/2021
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Provider Practice Location Address
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Address Line | 601 S GLENOAKS BLVD STE 200
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City | BURBANK
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State | CA
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Zip | 91502-2787
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Country | US
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Telephone | 818-940-3386
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Fax |
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Provider Business Mailing Address
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Address Line | 601 S GLENOAKS BLVD STE 200
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City | BURBANK
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State | CA
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Zip | 91502-2787
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Country | US
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Telephone | 818-940-3386
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | ASW86023
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW100705
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License Number State | CA
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