MEDICARE: MARYKATHERINE PROIETTA

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	103179	CA

General Provider Information

NPI Number	:	1740931351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYKATHERINE PROIETTA

Provider Business Mailing Address
First Line	:	12443 CULVER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-6612
Country	:	US
Telephone Number	:	315-559-0401
Fax Number	:

Provider Business Practice Location Address
First Line	:	2512 ARTESIA BLVD STE 305C
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-3269
Country	:	US
Telephone Number	:	424-261-8085
Fax Number	:

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

Provider Enumeration Date	:	01/14/2022
Last Update Date	:	01/14/2022

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Directions to “ MARYKATHERINE PROIETTA ” Practice Location

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