Provider Demographics
NPI:1437628450
Name:JOANNA MARY SAPORITO, LICENSED CLINICAL SOCIAL WORKER A PROF CORP
Entity Type:Organization
Organization Name:JOANNA MARY SAPORITO, LICENSED CLINICAL SOCIAL WORKER A PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:SAPORITO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:818-230-1081
Mailing Address - Street 1:1139 N BRAND BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-3012
Mailing Address - Country:US
Mailing Address - Phone:818-230-1081
Mailing Address - Fax:
Practice Address - Street 1:1139 N BRAND BLVD STE A
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-3012
Practice Address - Country:US
Practice Address - Phone:818-230-1081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA18817-6059OtherNPI