Provider Demographics
NPI:1356863013
Name:GOLOB, JAVANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:JAVANNE
Middle Name:
Last Name:GOLOB
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 1:707 COEUR D ALENE AVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-4924
Mailing Address - Country:US
Mailing Address - Phone:702-340-9799
Mailing Address - Fax:
Practice Address - Street 1:237 4TH AVE APT B2
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-8651
Practice Address - Country:US
Practice Address - Phone:424-835-1495
Practice Address - Fax:424-835-1495
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-13
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA779151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty