Provider Demographics
NPI:1154446409
Name:MENITOFF, ROSLYN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ROSLYN
Middle Name:
Last Name:MENITOFF
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 1:15131 MULHOLLAND DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1618
Mailing Address - Country:US
Mailing Address - Phone:310-882-0981
Mailing Address - Fax:
Practice Address - Street 1:15131 MULHOLLAND DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90077-1618
Practice Address - Country:US
Practice Address - Phone:310-882-0981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW 45061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1154446409Medicare NSC