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General NPI Number Information
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NPI Number | 1740881176
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Entity Type | Organization
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Legal Business Name | DGMANDEL A LICENSED CLINICAL SOCIAL WORKER CORPORATION
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Dates
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Enumeration Date | 11/03/2020
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Last Update Date | 11/03/2020
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Provider Practice Location Address
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Address Line | 5757 WILSHIRE BLVD STE 439
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City | LOS ANGELES
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State | CA
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Zip | 90036-3628
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Country | US
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Telephone | 310-579-9355
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Fax |
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Provider Business Mailing Address
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Address Line | 137 N LARCHMONT BLVD # 476
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City | LOS ANGELES
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State | CA
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Zip | 90004-3704
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Country | US
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Telephone | 323-325-5346
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DENICA GORDON MANDEL
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Credential | M.A., MSW, LCSW
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Telephone | 323-325-5346
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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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