Basic Information
| Provider Information | |||||||||
| NPI: | 1306923503 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERWALD | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | HENRY | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | L.C.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1737 N ORANGE DR | ||||||||
| Address2: | APT. 2 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900284372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2134475271 | ||||||||
| FaxNumber: | 3234672647 | ||||||||
| Practice Location | |||||||||
| Address1: | 1224 VINE ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900381612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237696159 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCS5973 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.