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General NPI Number Information
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NPI Number | 1912669557
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Entity Type | Organization
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Legal Business Name | PA'LANTE THERAPY LICENSED CLINICAL SOCIAL WORKER, INC.
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Dates
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Enumeration Date | 10/12/2021
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Last Update Date | 10/13/2021
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Provider Practice Location Address
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Address Line | 9509 MAIE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90002-2350
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Country | US
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Telephone | 323-633-9804
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Fax |
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Provider Business Mailing Address
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Address Line | 3848 TWEEDY BLVD STE B2
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City | SOUTH GATE
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State | CA
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Zip | 90280-6168
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Country | US
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Telephone | 323-522-2629
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | YANIRA HERNANDEZ
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Credential | LCSW
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Telephone | 323-633-9804
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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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