Provider Demographics
NPI:1871634543
Name:BARRAZA, MATTHEW ARTHUR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:ARTHUR
Last Name:BARRAZA
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 1:510 S. VERMONT AVE.
Mailing Address - Street 2:EOTD 21ST FLOOR
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-1912
Mailing Address - Country:US
Mailing Address - Phone:213-305-2981
Mailing Address - Fax:
Practice Address - Street 1:510 S VERMONT AVE FL 21
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1992
Practice Address - Country:US
Practice Address - Phone:213-996-1343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS230131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA383955OtherMHN NETWORK PROVIDER NO.