MEDICARE: MS. DARLS CENTOLA 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	21401	CA

General Provider Information

NPI Number	:	1861551053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DARLS CENTOLA LCSW

Provider Business Mailing Address
First Line	:	12240 VENICE BLVD STE 15A
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-3891
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12240 VENICE BLVD STE 15A
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-3891
Country	:	US
Telephone Number	:	310-738-3609
Fax Number	:

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

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	04/25/2018

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