Provider Demographics
NPI:1023895802
Name:ADRIANNE AVERBUKH A LICENSED CLINICAL SOCIAL WORKER CORPORATION
Entity type:Organization
Organization Name:ADRIANNE AVERBUKH A LICENSED CLINICAL SOCIAL WORKER CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ADRIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:AVERBUKH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-200-4614
Mailing Address - Street 1:1714 IVAR AVE # D
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-5124
Mailing Address - Country:US
Mailing Address - Phone:323-471-3212
Mailing Address - Fax:323-464-9161
Practice Address - Street 1:1714 IVAR AVE # D
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-5124
Practice Address - Country:US
Practice Address - Phone:323-471-3212
Practice Address - Fax:323-464-9161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-13
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty