Provider Demographics
NPI:1841749686
Name:REDDELL, ROBYN (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:
Last Name:REDDELL
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 1:503 OLYMPIC BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-3311
Mailing Address - Country:US
Mailing Address - Phone:310-450-4050
Mailing Address - Fax:
Practice Address - Street 1:503 OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-3311
Practice Address - Country:US
Practice Address - Phone:310-450-4050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW808891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical