MEDICARE: LANI CORAL CRESCENZI ACSW

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	21340	CA
2	101YM0800X	Mental Health Counselor	ASW21340	CA

General Provider Information

NPI Number	:	1881736494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANI CORAL CRESCENZI ACSW

Provider Business Mailing Address
First Line	:	4434 9TH AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90043-1327
Country	:	US
Telephone Number	:	310-569-2219
Fax Number	:

Provider Business Practice Location Address
First Line	:	4670 S. SEPULVEDA BLV.
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-5407
Country	:	US
Telephone Number	:	310-390-6612
Fax Number	:

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

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	04/14/2008

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