Provider Demographics
NPI:1457840258
Name:HEALING BLUE INC A LICENSED CLINICAL SOCIAL WORKER COPORATION
Entity Type:Organization
Organization Name:HEALING BLUE INC A LICENSED CLINICAL SOCIAL WORKER COPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:323-351-3633
Mailing Address - Street 1:16001 HORACE ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-5322
Mailing Address - Country:US
Mailing Address - Phone:323-351-3633
Mailing Address - Fax:
Practice Address - Street 1:10315 WOODLEY AVE STE 215
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6950
Practice Address - Country:US
Practice Address - Phone:818-945-9075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-07
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW807031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA80703OtherLCSW LICENSE