Provider Demographics
NPI:1104003359
Name:LA VERNE, DANA R (BA SOCIAL WORK)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:R
Last Name:LA VERNE
Suffix:
Gender:F
Credentials:BA SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6839 NEWCASTLE AVE
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4617
Mailing Address - Country:US
Mailing Address - Phone:818-344-0696
Mailing Address - Fax:
Practice Address - Street 1:14558 SYLVAN ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-2324
Practice Address - Country:US
Practice Address - Phone:818-787-4151
Practice Address - Fax:818-787-2840
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)