Provider Demographics
NPI:1003167404
Name:BAGNOL, VALERIE LEDITH (MSW)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:LEDITH
Last Name:BAGNOL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70024
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90070-0024
Mailing Address - Country:US
Mailing Address - Phone:714-309-6800
Mailing Address - Fax:
Practice Address - Street 1:3303 N BROADWAY FL 4
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031-2803
Practice Address - Country:US
Practice Address - Phone:213-219-4164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-25
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA686941041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical