Provider Demographics
NPI:1437838059
Name:MAKIRI, GLEN EDWARD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GLEN
Middle Name:EDWARD
Last Name:MAKIRI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15113 SATICOY ST APT 9
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-4904
Mailing Address - Country:US
Mailing Address - Phone:818-358-8795
Mailing Address - Fax:
Practice Address - Street 1:15113 SATICOY ST APT 9
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4904
Practice Address - Country:US
Practice Address - Phone:818-358-8795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA183031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical