Basic Information
| Provider Information | |||||||||
| NPI: | 1437224805 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MADRIL | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | LCSW, BCD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10350 SANTA MONICA BLVD | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900255055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3233152598 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4900 SERRANIA AVE | ||||||||
| Address2: | |||||||||
| City: | WOODLAND HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913643301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183471577 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2006 | ||||||||
| LastUpdateDate: | 11/14/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCS20874 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.