Provider Demographics
NPI:1235800707
Name:PATEL, NISHA MAHESH (ACSW)
Entity Type:Individual
Prefix:
First Name:NISHA
Middle Name:MAHESH
Last Name:PATEL
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 SOUTHFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90274-5267
Mailing Address - Country:US
Mailing Address - Phone:310-663-1003
Mailing Address - Fax:
Practice Address - Street 1:11515 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-5913
Practice Address - Country:US
Practice Address - Phone:310-361-3140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-24
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA111581OtherACSW