Basic Information
| Provider Information | |||||||||
| NPI: | 1528142015 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WERNER | ||||||||
| FirstName: | MANDANA | ||||||||
| MiddleName: | IGHANI | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | L.C.S.W | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | IGHANI | ||||||||
| OtherFirstName: | MANDANA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | L.C.S.W | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4819 WIGGIN ST | ||||||||
| Address2: | |||||||||
| City: | OAK PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913774848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8052795919 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 19231 VICTORY BLVD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | RESEDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913356308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187084500 | ||||||||
| FaxNumber: | 8186541956 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 03/28/2017 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | LCS23253 | CA | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | LCS23253 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.