MEDICARE: ZARA GARRY, LICENSED CLINICAL SOCIAL WORKER, INC

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

General Provider Information

NPI Number	:	1891561080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZARA GARRY, LICENSED CLINICAL SOCIAL WORKER, INC

Provider Business Mailing Address
First Line	:	150 S GLENOAKS BLVD # 9161
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91502-1314
Country	:	US
Telephone Number	:	818-319-8586
Fax Number	:

Provider Business Practice Location Address
First Line	:	1216 SPAZIER AVE UNIT A
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91201-1322
Country	:	US
Telephone Number	:	818-319-8586
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ZARA GARRY
Credential	:	LCSW
Telephone Number	:	818-319-8586

Provider Enumeration Date	:	11/28/2023
Last Update Date	:	11/28/2023

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