Provider Demographics
NPI:1588796148
Name:CASABELLA, AUDRA JO (MSW)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:JO
Last Name:CASABELLA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:AUDRA
Other - Middle Name:JO
Other - Last Name:PENAFLORIDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26332 MARGARITA LN
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-6737
Mailing Address - Country:US
Mailing Address - Phone:626-673-2252
Mailing Address - Fax:
Practice Address - Street 1:8019 COMPTON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90001-3409
Practice Address - Country:US
Practice Address - Phone:323-586-7333
Practice Address - Fax:323-319-1998
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW20787101YM0800X
CALCSW 265501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01605808Medicare UPIN