Provider Demographics
NPI:1700035318
Name:APODACA, LAWRENCE RUDOLPH (LCSW)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:RUDOLPH
Last Name:APODACA
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 1:4430 SAN RAFAEL AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-3127
Mailing Address - Country:US
Mailing Address - Phone:323-256-5653
Mailing Address - Fax:
Practice Address - Street 1:4430 SAN RAFAEL AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-3127
Practice Address - Country:US
Practice Address - Phone:323-256-5653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS85581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical