Provider Demographics
NPI:1790839298
Name:LASAROW-MILLER, ELAINE (MSW)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:LASAROW-MILLER
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 1:8632 S SEPULVEDA BLVD
Mailing Address - Street 2:#200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-4013
Mailing Address - Country:US
Mailing Address - Phone:310-386-9320
Mailing Address - Fax:310-337-7333
Practice Address - Street 1:8632 S SEPULVEDA BLVD
Practice Address - Street 2:#200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-4013
Practice Address - Country:US
Practice Address - Phone:310-386-9320
Practice Address - Fax:310-337-7333
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS67481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical