MEDICARE: HAVI MICHELE WOLFSON L.C.S.W.

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	22483	CA

General Provider Information

NPI Number	:	1952446197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAVI MICHELE WOLFSON L.C.S.W.

Provider Business Mailing Address
First Line	:	12401 WILSHIRE BLVD
Second Line	:	SUITE 300
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1085
Country	:	US
Telephone Number	:	310-207-9896
Fax Number	:	310-820-3595

Provider Business Practice Location Address
First Line	:	6505 WILSHIRE BLVD
Second Line	:	5TH FLOOR
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-4917
Country	:	US
Telephone Number	:	323-761-8800
Fax Number	:	323-761-8801

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

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	07/08/2007

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