MEDICARE: MR. CHARLES ALOYSIUS LENNON JR. 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	20090	CA

General Provider Information

NPI Number	:	1598846800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES ALOYSIUS LENNON JR. LCSW

Provider Business Mailing Address
First Line	:	550 S VERMONT AVE
Second Line	:	EOB/LAPD SMART, 10TH FLOOR
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-1912
Country	:	US
Telephone Number	:	213-996-1325
Fax Number	:	213-996-1350

Provider Business Practice Location Address
First Line	:	100 W 1ST ST
Second Line	:	MEU - ROOM 630
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-4112
Country	:	US
Telephone Number	:	213-996-1325
Fax Number	:	213-996-1350

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	02/20/2014

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Directions to “ MR. CHARLES ALOYSIUS LENNON JR. LCSW” Practice Location

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