MEDICARE: MS. AISHA CHERISE POWELL 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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	18382	CA
2	1041C0700X	Clinical Social Worker	62907	CA

General Provider Information

NPI Number	:	1912026030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AISHA CHERISE POWELL LCSW

Provider Business Mailing Address
First Line	:	6822 FORBES AVE
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91406-4579
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4635 DON ZAREMBO DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-4122
Country	:	US
Telephone Number	:	310-871-4252
Fax Number	:

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	01/07/2023

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