MEDICARE: JOANNA LESLI GILLIS 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	66593	CA

General Provider Information

NPI Number	:	1942755517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNA LESLI GILLIS LCSW

Provider Business Mailing Address
First Line	:	1940 CENTURY PARK E
Second Line	:	SUITE 425
City	:	LOS ANGELES
State	:	CA
Zip	:	90067-1700
Country	:	US
Telephone Number	:	310-896-8427
Fax Number	:

Provider Business Practice Location Address
First Line	:	2080 CENTURY PARK E STE 1406
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90067-2017
Country	:	US
Telephone Number	:	310-896-8427
Fax Number	:	310-268-1015

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

Provider Enumeration Date	:	08/23/2016
Last Update Date	:	06/10/2019

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