Basic Information
| Provider Information | |||||||||
| NPI: | 1598895401 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AUCELLA | ||||||||
| FirstName: | VANESSA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 460 E CARSON PLAZA DR | ||||||||
| Address2: | SUITE 122 | ||||||||
| City: | CARSON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907463228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105239500 | ||||||||
| FaxNumber: | 3102252725 | ||||||||
| Practice Location | |||||||||
| Address1: | 460 E CARSON PLAZA DR | ||||||||
| Address2: | SUITE 122 | ||||||||
| City: | CARSON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907463228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105239500 | ||||||||
| FaxNumber: | 3102252725 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 06/26/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | ASW20097 | CA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | ASW 33071 | CA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YM0800X | ASW33071 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | LCS 29647 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 0007300 | 05 | CA | MEDICAID |