Provider Demographics
NPI:1417091109
Name:YORK, KRISTIE L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTIE
Middle Name:L
Last Name:YORK
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 1:1605 EASTLAKE AVE
Mailing Address - Street 2:MENTAL HEALTH UNIT
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1009
Mailing Address - Country:US
Mailing Address - Phone:323-226-8826
Mailing Address - Fax:323-226-8820
Practice Address - Street 1:1605 EASTLAKE AVE
Practice Address - Street 2:MENTAL HEALTH UNIT
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1009
Practice Address - Country:US
Practice Address - Phone:323-226-8826
Practice Address - Fax:323-226-8820
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS227651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical