Basic Information
| Provider Information | |||||||||
| NPI: | 1598846800 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LENNON | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | ALOYSIUS | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 S VERMONT AVE | ||||||||
| Address2: | EOB/LAPD SMART, 10TH FLOOR | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900201912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2139961325 | ||||||||
| FaxNumber: | 2139961350 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 W 1ST ST | ||||||||
| Address2: | MEU - ROOM 630 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900124112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2139961325 | ||||||||
| FaxNumber: | 2139961350 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 02/20/2014 | ||||||||
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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 | 20090 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.