MEDICARE: ADRIANNE AVERBUKH A LICENSED CLINICAL SOCIAL WORKER CORPORATION

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103TC1900X	Counseling Psychologist
2	104100000X	Social Worker
3	1041S0200X	School Social Worker
4	251S00000X	Community/Behavioral Health Agency
5	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1023895802
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADRIANNE AVERBUKH A LICENSED CLINICAL SOCIAL WORKER CORPORATION

Provider Business Mailing Address
First Line	:	1714 IVAR AVE # D
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-5124
Country	:	US
Telephone Number	:	323-471-3212
Fax Number	:	323-464-9161

Provider Business Practice Location Address
First Line	:	1714 IVAR AVE # D
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-5124
Country	:	US
Telephone Number	:	323-471-3212
Fax Number	:	323-464-9161

Authorized Official
Title or Position	:	CEO
Name	:	ADRIANNE AVERBUKH
Credential	:
Telephone Number	:	323-200-4614

Provider Enumeration Date	:	09/13/2023
Last Update Date	:	10/19/2023

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