Provider Demographics
NPI:1689192122
Name:TAHA, DANA MOHAMMED (LCSW 104619)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:MOHAMMED
Last Name:TAHA
Suffix:
Gender:F
Credentials:LCSW 104619
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12400 VENTURA BLVD STE 1333
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2406
Mailing Address - Country:US
Mailing Address - Phone:323-537-9907
Mailing Address - Fax:
Practice Address - Street 1:12400 VENTURA BLVD STE 1333
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2406
Practice Address - Country:US
Practice Address - Phone:323-537-9907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1046191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical