MEDICARE: JACOB WANGEL-BROWN 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	083416	NY
2	1041C0700X	Clinical Social Worker	LCSW87679	CA

General Provider Information

NPI Number	:	1861753857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB WANGEL-BROWN LCSW

Provider Business Mailing Address
First Line	:	1910 W SUNSET BLVD STE 460
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-3262
Country	:	US
Telephone Number	:	917-310-4752
Fax Number	:

Provider Business Practice Location Address
First Line	:	1910 W SUNSET BLVD STE 460
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-3262
Country	:	US
Telephone Number	:	917-310-4752
Fax Number	:

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

Provider Enumeration Date	:	06/06/2012
Last Update Date	:	07/25/2022

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