Provider Demographics
NPI:1932132578
Name:BRANZBURG, ALLA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ALLA
Middle Name:
Last Name:BRANZBURG
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 1:21243 VENTURA BLVD
Mailing Address - Street 2:SUITE 229
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2109
Mailing Address - Country:US
Mailing Address - Phone:818-216-5894
Mailing Address - Fax:747-888-3331
Practice Address - Street 1:21243 VENTURA BLVD
Practice Address - Street 2:SUITE 229
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2109
Practice Address - Country:US
Practice Address - Phone:818-216-5894
Practice Address - Fax:747-888-3331
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS213091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW21309AMedicare ID - Type UnspecifiedLCSW
CASW21309Medicare ID - Type UnspecifiedLCSW