=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790561488
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PATRICIA BECERRA, LCSW
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2023
-----------------------------------------------------
Last Update Date | 09/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 633 S BREA BLVD STE 201
-----------------------------------------------------
City | BREA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92821-5308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-506-8434
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 633 S BREA BLVD STE 201
-----------------------------------------------------
City | BREA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92821-5308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-506-8434
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GROUP PRACTICE OWNER
-----------------------------------------------------
Name | PATRICIA BECERRA
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 626-506-8434
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------