MEDICARE: SANDRA R NOWOSIOLSKI 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	104100000X	Social Worker
2	171M00000X	Case Manager/Care Coordinator
3	1041C0700X	Clinical Social Worker	110814	CA

General Provider Information

NPI Number	:	1750978474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA R NOWOSIOLSKI LCSW

Provider Business Mailing Address
First Line	:	12553 KILLION ST
Second Line	:
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-1533
Country	:	US
Telephone Number	:	310-666-6456
Fax Number	:

Provider Business Practice Location Address
First Line	:	12553 KILLION ST
Second Line	:
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-1533
Country	:	US
Telephone Number	:	310-666-6456
Fax Number	:

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

Provider Enumeration Date	:	12/29/2020
Last Update Date	:	08/11/2025

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