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General NPI Number Information
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NPI Number | 1831447663
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Entity Type | Organization
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Legal Business Name | DR. JORDANA MANSBACHER, LCND CLIN SCL WORKER A PROFESSIONAL CORP
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Dates
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Enumeration Date | 08/28/2012
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Last Update Date | 10/01/2012
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Provider Practice Location Address
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Address Line | 5519 S CENTINELA AVE SUITE 105
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City | LOS ANGELES
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State | CA
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Zip | 90066-6945
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Country | US
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Telephone | 310-301-9121
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Fax | 310-390-8578
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Provider Business Mailing Address
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Address Line | 5519 S CENTINELA AVE SUITE 105
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City | LOS ANGELES
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State | CA
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Zip | 90066-6945
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Country | US
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Telephone | 310-301-9121
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Fax | 310-390-8578
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Authorized Official
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Title or Position | OWNER/PRACTITIONER
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Name | DR. JORDANA MANSBACHER
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Credential | PSY.D, LCSW
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Telephone | 310-301-9121
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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 | LCS21516
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License Number State | CA
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