Basic Information
| Provider Information | |||||||||
| NPI: | 1801185111 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LOS ANGELES COUNTY DEPARTMENT OF MENTAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12440 IMPERIAL HWY STE 116 | ||||||||
| Address2: | |||||||||
| City: | NORWALK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906508347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626515025 | ||||||||
| FaxNumber: | 5628683749 | ||||||||
| Practice Location | |||||||||
| Address1: | 12440 IMPERIAL HWY STE 116 | ||||||||
| Address2: | |||||||||
| City: | NORWALK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906508347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626515025 | ||||||||
| FaxNumber: | 5628683749 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2011 | ||||||||
| LastUpdateDate: | 04/07/2011 | ||||||||
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| AuthorizedOfficialLastName: | SHAU | ||||||||
| AuthorizedOfficialFirstName: | SANJE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SUPERVISING PSYCHIATRIC SOCIAL WORK | ||||||||
| AuthorizedOfficialTelephone: | 5626515025 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | L.C.S.W. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.