Provider Demographics
NPI:1629346929
Name:THAKKAR, AMMIE (MSW)
Entity Type:Individual
Prefix:
First Name:AMMIE
Middle Name:
Last Name:THAKKAR
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11728 WILSHIRE BLVD
Mailing Address - Street 2:B209
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6473
Mailing Address - Country:US
Mailing Address - Phone:714-309-2174
Mailing Address - Fax:
Practice Address - Street 1:11728 WILSHIRE BLVD
Practice Address - Street 2:B209
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6473
Practice Address - Country:US
Practice Address - Phone:714-309-2174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker