MEDICARE: ANNIE THE THERAPIST 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	:	1972331437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANNIE THE THERAPIST LICENSED CLINICAL SOCIAL WORKER, INC

Provider Business Mailing Address
First Line	:	7190 W SUNSET BLVD # 7D
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-4415
Country	:	US
Telephone Number	:	323-301-3962
Fax Number	:

Provider Business Practice Location Address
First Line	:	1910 W SUNSET BLVD STE 800
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-3283
Country	:	US
Telephone Number	:	323-301-3962
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ANA LUZ LOPEZ
Credential	:	LCSW
Telephone Number	:	818-689-5387

Provider Enumeration Date	:	07/24/2024
Last Update Date	:	09/03/2025

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