Provider Demographics
NPI:1659553071
Name:CHERNOFSKY, AUDREY (RPT)
Entity Type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:
Last Name:CHERNOFSKY
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 S BEVERLY DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-3036
Mailing Address - Country:US
Mailing Address - Phone:310-963-8196
Mailing Address - Fax:
Practice Address - Street 1:1515 S BEVERLY DR
Practice Address - Street 2:SUITE 102
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-3036
Practice Address - Country:US
Practice Address - Phone:310-963-8196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10575172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker