Provider Demographics
NPI:1467142737
Name:PAUL MICHAEL MASTROFRANCESCO, LICENSED CLINICAL SOCIAL WORKER PC
Entity Type:Organization
Organization Name:PAUL MICHAEL MASTROFRANCESCO, LICENSED CLINICAL SOCIAL WORKER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MASTROFRANCESCO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:424-291-2219
Mailing Address - Street 1:1851 COMSTOCK AVE # B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5014
Mailing Address - Country:US
Mailing Address - Phone:424-291-2219
Mailing Address - Fax:
Practice Address - Street 1:11301 W OLYMPIC BLVD # 121-303
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1653
Practice Address - Country:US
Practice Address - Phone:424-291-2219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1285100982OtherPAUL MICHAEL MASTROFRANCESCO