Provider Demographics
NPI:1134675440
Name:AVELLINO, NOELLE ANTOINETTE (ASW)
Entity Type:Individual
Prefix:MISS
First Name:NOELLE
Middle Name:ANTOINETTE
Last Name:AVELLINO
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4041 INGLEWOOD BLVD.
Mailing Address - Street 2:APT 6.
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066
Mailing Address - Country:US
Mailing Address - Phone:310-619-3302
Mailing Address - Fax:
Practice Address - Street 1:3384 MOTOR AVE.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034
Practice Address - Country:US
Practice Address - Phone:424-290-8725
Practice Address - Fax:310-317-7790
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW633851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical