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NPI Code Detail

MEDICARE: MR. ANTHONY MADRIL III LCSW, BCD

MEDICARE: MR. ANTHONY MADRIL III LCSW, BCD
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 WorkerLCS20874CA

General Provider Information

NPI Number : 1437224805
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ANTHONY MADRIL III LCSW, BCD
Provider Business Mailing Address
First Line : 10350 SANTA MONICA BLVD
Second Line : SUITE 310
City : LOS ANGELES
State : CA
Zip : 90025-5055
Country : US
Telephone Number : 323-315-2598
Fax Number :
Provider Business Practice Location Address
First Line : 4900 SERRANIA AVE
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91364-3301
Country : US
Telephone Number : 818-347-1577
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2006
Last Update Date : 11/14/2014

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