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NPI Code Detail

MEDICARE: ANGELIC ROME LCSW

MEDICARE: ANGELIC ROME LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerLCS 29342CA

General Provider Information

NPI Number : 1003932559
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELIC ROME LCSW
Provider Business Mailing Address
First Line : 415 LONGFELLOW AVE
Second Line :
City : HERMOSA BEACH
State : CA
Zip : 90254-2119
Country : US
Telephone Number : 310-902-3230
Fax Number :
Provider Business Practice Location Address
First Line : 711 S NEW HAMPSHIRE AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90005-1831
Country : US
Telephone Number : 213-807-1637
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2007
Last Update Date : 03/25/2013

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Directions to “ ANGELIC ROME LCSW” Practice Location

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