Provider Demographics
NPI:1659462802
Name:ATTRELL, RONALD L (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:L
Last Name:ATTRELL
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 1:819 N HARBOR DR
Mailing Address - Street 2:SUITE 330
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-2006
Mailing Address - Country:US
Mailing Address - Phone:310-379-2999
Mailing Address - Fax:310-379-7535
Practice Address - Street 1:819 N HARBOR DR
Practice Address - Street 2:SUITE 330
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-2006
Practice Address - Country:US
Practice Address - Phone:310-379-2999
Practice Address - Fax:310-379-7535
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0051361041C0700X
CALCS 245231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
800003250Medicare PIN