Provider Demographics
NPI:1124179577
Name:ANTELMAN, PEGGY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:
Last Name:ANTELMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1363 HUNT TER
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-2471
Mailing Address - Country:US
Mailing Address - Phone:310-326-4607
Mailing Address - Fax:
Practice Address - Street 1:3424 W CARSON ST
Practice Address - Street 2:SUITE 580
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-5701
Practice Address - Country:US
Practice Address - Phone:310-784-8856
Practice Address - Fax:310-326-6368
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS118011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical