Provider Demographics
NPI:1932297280
Name:BEFORT, MARK MATTHEW (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:MATTHEW
Last Name:BEFORT
Suffix:
Gender:M
Credentials:LCSW
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Mailing Address - Street 1:4701 E CESAR E CHAVEZ AVE
Mailing Address - Street 2:ROYBAL MENTAL HEALTH--SECOND FLOOR
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-1209
Mailing Address - Country:US
Mailing Address - Phone:323-267-3400
Mailing Address - Fax:323-260-5201
Practice Address - Street 1:4701 E CESAR E CHAVEZ AVE
Practice Address - Street 2:ROYBAL MENTAL HEALTH--SECOND FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-1209
Practice Address - Country:US
Practice Address - Phone:323-267-3400
Practice Address - Fax:323-260-5201
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CALCS 208071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA011870Medicaid