MEDICARE: MRS. CATALAINE KNELL LCSW 99247

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	390200000X	Student in an Organized Health Care Education/Training Program
2	1041C0700X	Clinical Social Worker	99247	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01536011	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1376095323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CATALAINE KNELL LCSW 99247

Provider Business Mailing Address
First Line	:	436 N OXFORD AVE APT 105
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-2780
Country	:	US
Telephone Number	:	323-957-7824
Fax Number	:

Provider Business Practice Location Address
First Line	:	4221 WILSHIRE BLVD STE 170-16
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-3519
Country	:	US
Telephone Number	:	323-957-7824
Fax Number	:

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

Provider Enumeration Date	:	10/25/2016
Last Update Date	:	02/15/2022

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