MEDICARE: EG THERAPY CENTERS

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

General Provider Information

NPI Number	:	1649862954
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EG THERAPY CENTERS

Provider Business Mailing Address
First Line	:	6854 COSTELLO AVE
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91405-4105
Country	:	US
Telephone Number	:	818-824-1159
Fax Number	:

Provider Business Practice Location Address
First Line	:	7576 SAN FERNANDO RD
Second Line	:
City	:	SUN VALLEY
State	:	CA
Zip	:	91352-4346
Country	:	US
Telephone Number	:	818-824-1159
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL SOCIAL WORKER
Name	:	MRS. ELIZABETH GASPARYAN
Credential	:	LCSW
Telephone Number	:	818-824-1159

Provider Enumeration Date	:	02/08/2021
Last Update Date	:	10/21/2021

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