Provider Demographics
NPI:1407073950
Name:ZAYANI, MARY KILLEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KILLEAN
Last Name:ZAYANI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:BRIDGET
Other - Last Name:KILLEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:323 N PRAIRIE AVE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4502
Mailing Address - Country:US
Mailing Address - Phone:310-846-2100
Mailing Address - Fax:310-677-7205
Practice Address - Street 1:323 N PRAIRIE AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4502
Practice Address - Country:US
Practice Address - Phone:310-846-2100
Practice Address - Fax:310-677-7205
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0757551041C0700X
CALCS211991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical