Provider Demographics
NPI:1821576828
Name:SEIFFERT, CORNELIA VERNA MATHILDE (LCSW)
Entity Type:Individual
Prefix:
First Name:CORNELIA
Middle Name:VERNA MATHILDE
Last Name:SEIFFERT
Suffix:
Gender:F
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:PO BOX 94431
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91109-4431
Mailing Address - Country:US
Mailing Address - Phone:323-886-2417
Mailing Address - Fax:626-565-1565
Practice Address - Street 1:1820 W ORANGEWOOD AVE STE 105
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-5052
Practice Address - Country:US
Practice Address - Phone:323-886-2417
Practice Address - Fax:626-565-1565
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA81461101YM0800X, 104100000X
CA1041021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker