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NPI Code Detail

MEDICARE: MRS. ARACELY MIRON SORRELS LCSW

MEDICARE: MRS. ARACELY MIRON SORRELS 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 WorkerASW27690CA
21041C0700XClinical Social WorkerLCSW64391CA

General Provider Information

NPI Number : 1326173287
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ARACELY MIRON SORRELS LCSW
Provider Business Mailing Address
First Line : 760 MOUNTAIN VIEW ST
Second Line :
City : ALTADENA
State : CA
Zip : 91001-4925
Country : US
Telephone Number : 626-214-0353
Fax Number :
Provider Business Practice Location Address
First Line : 760 MOUNTAIN VIEW ST
Second Line :
City : ALTADENA
State : CA
Zip : 91001-4925
Country : US
Telephone Number : 626-491-2357
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2007
Last Update Date : 07/21/2022

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