Provider Demographics
NPI:1538511159
Name:AVITIA, JAVIER (LCSW)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:AVITIA
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 1:631 MAPLE AVE # B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90014-2211
Mailing Address - Country:US
Mailing Address - Phone:213-842-0936
Mailing Address - Fax:213-626-2458
Practice Address - Street 1:631 MAPLE AVE # B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90014-2211
Practice Address - Country:US
Practice Address - Phone:213-842-0936
Practice Address - Fax:213-626-2458
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104100000X
CA1004221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker