Provider Demographics
NPI:1295043081
Name:ZDANOVICH, CHIWON (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CHIWON
Middle Name:
Last Name:ZDANOVICH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:CHIWON
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:520 S LA FAYETTE PARK PL
Mailing Address - Street 2:300
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-1607
Mailing Address - Country:US
Mailing Address - Phone:213-252-2100
Mailing Address - Fax:
Practice Address - Street 1:520 S LA FAYETTE PARK PL
Practice Address - Street 2:300
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-1607
Practice Address - Country:US
Practice Address - Phone:213-252-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS702231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical