Provider Demographics
NPI:1336649326
Name:SEDANO, VANESSA MARIE (MSW, LCSW #109538)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:MARIE
Last Name:SEDANO
Suffix:
Gender:F
Credentials:MSW, LCSW #109538
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 LONG BEACH BLVD STE C8
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-6013
Mailing Address - Country:US
Mailing Address - Phone:626-714-0013
Mailing Address - Fax:
Practice Address - Street 1:3620 LONG BEACH BLVD STE C8
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-6013
Practice Address - Country:US
Practice Address - Phone:562-912-0638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1095381041C0700X
CA90571101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical