Provider Demographics
NPI:1346505419
Name:MAOUDA, TALI ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TALI
Middle Name:ELIZABETH
Last Name:MAOUDA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TALI
Other - Middle Name:ELIZABETH
Other - Last Name:BAR-OR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2211 CORINTH AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1621
Mailing Address - Country:US
Mailing Address - Phone:424-977-6587
Mailing Address - Fax:
Practice Address - Street 1:2211 CORINTH AVE STE 203
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1621
Practice Address - Country:US
Practice Address - Phone:424-977-6587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2023-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108331041C0700X
CA74724101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical