MEDICARE: DR. JORDANA MANSBACHER PSY. D, 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
1	1041C0700X	Clinical Social Worker	LCS 21516	CA

General Provider Information

NPI Number	:	1316963937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORDANA MANSBACHER PSY. D, LCSW

Provider Business Mailing Address
First Line	:	3456 MAPLEWOOD AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-2253
Country	:	US
Telephone Number	:	310-570-7072
Fax Number	:

Provider Business Practice Location Address
First Line	:	3456 MAPLEWOOD AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-2253
Country	:	US
Telephone Number	:	310-570-7072
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	04/17/2023

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