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General NPI Number Information
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NPI Number | 1801612965
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Entity Type | Individual
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Provider Name | ELENA FASAN LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/22/2024
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 2936 1/2 S LA SALLE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90018-3095
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Country | US
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Telephone | 213-798-1594
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Fax |
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Provider Business Mailing Address
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Address Line | 1125 E BROADWAY # 1002
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City | GLENDALE
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State | CA
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Zip | 91205-1315
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Country | US
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Telephone | 323-991-6692
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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 | 88083
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License Number State | CA
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