Provider Demographics
NPI:1497133268
Name:ELLEN KIMMEL LICENSED CLINICAL SOCIAL WORKER INCORPORATED
Entity Type:Organization
Organization Name:ELLEN KIMMEL LICENSED CLINICAL SOCIAL WORKER INCORPORATED
Other - Org Name:ELLEN KIMMEL LCSW
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:KIMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:323-447-8372
Mailing Address - Street 1:1850 SAWTELLE BLVD STE 490
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-7028
Mailing Address - Country:US
Mailing Address - Phone:323-447-8372
Mailing Address - Fax:
Practice Address - Street 1:1850 SAWTELLE BLVD STE 490
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7028
Practice Address - Country:US
Practice Address - Phone:323-447-8372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11387101YM0800X, 101YP2500X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty