=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780221317
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KN THERAPY LCSW GROUP INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2019
-----------------------------------------------------
Last Update Date | 02/15/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 N MACLAY AVE STE G
-----------------------------------------------------
City | SAN FERNANDO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91340-2940
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-803-9510
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 N MACLAY AVE STE 114
-----------------------------------------------------
City | SAN FERNANDO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91340-2987
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-803-9510
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOTHERAPIST
-----------------------------------------------------
Name | KAREN NAVARRETE-BELL
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 323-803-9510
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------