MEDICARE: JOANNA MARY SAPORITO, LICENSED CLINICAL SOCIAL WORKER A PROF CORP

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	305S00000X	Point of Service

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	18817-6059	OTHER	CA	NPI

General Provider Information

NPI Number	:	1437628450
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOANNA MARY SAPORITO, LICENSED CLINICAL SOCIAL WORKER A PROF CORP

Provider Business Mailing Address
First Line	:	1139 N BRAND BLVD STE A
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91202-3012
Country	:	US
Telephone Number	:	818-230-1081
Fax Number	:

Provider Business Practice Location Address
First Line	:	1139 N BRAND BLVD STE A
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91202-3012
Country	:	US
Telephone Number	:	818-230-1081
Fax Number	:

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	JOANNA MARY SAPORITO
Credential	:	LCSW
Telephone Number	:	818-230-1081

Provider Enumeration Date	:	11/19/2018
Last Update Date	:	11/19/2018

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