Provider Demographics
NPI:1417691429
Name:OURFALIAN, LAURA JACQUELINE (MSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JACQUELINE
Last Name:OURFALIAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11573
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91226-7573
Mailing Address - Country:US
Mailing Address - Phone:818-450-6688
Mailing Address - Fax:
Practice Address - Street 1:223 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4380
Practice Address - Country:US
Practice Address - Phone:818-241-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA873561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical