Provider Demographics
NPI:1669559589
Name:LOS ANGELES DEPARTMENT OF MENTAL HEALTH
Entity type:Organization
Organization Name:LOS ANGELES DEPARTMENT OF MENTAL HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC SOCIAL WORKER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ROSARIO
Authorized Official - Last Name:CALVILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:323-887-5788
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-0008
Mailing Address - Country:US
Mailing Address - Phone:323-972-3495
Mailing Address - Fax:
Practice Address - Street 1:4701 E CESAR E CHAVEZ AVE FL 2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-1209
Practice Address - Country:US
Practice Address - Phone:323-887-5788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAASW20875OtherASSOCIATE CLINICAL SOCIAL