Provider Demographics
NPI:1578275863
Name:TALI MAOUDA LICENSED CLINICAL SOCIAL WORKER INC
Entity Type:Organization
Organization Name:TALI MAOUDA LICENSED CLINICAL SOCIAL WORKER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TALI
Authorized Official - Middle Name:
Authorized Official - Last Name:MAOUDA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:424-977-6587
Mailing Address - Street 1:8549 WILSHIRE BLVD # 2361
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3104
Mailing Address - Country:US
Mailing Address - Phone:424-977-6587
Mailing Address - Fax:
Practice Address - Street 1:2211 CORINTH AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1650
Practice Address - Country:US
Practice Address - Phone:424-977-6587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty