Provider Demographics
NPI:1275785800
Name:BLAU, RONI SUSAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:RONI
Middle Name:SUSAN
Last Name:BLAU
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 1:11939 KIOWA AVE
Mailing Address - Street 2:APT 8
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-7010
Mailing Address - Country:US
Mailing Address - Phone:310-502-4701
Mailing Address - Fax:
Practice Address - Street 1:11939 KIOWA AVE
Practice Address - Street 2:APT 8
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-7010
Practice Address - Country:US
Practice Address - Phone:310-502-4701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA242031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical