Provider Demographics
NPI:1962846576
Name:BANDA, OMAR (ASW)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:BANDA
Suffix:
Gender:M
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 LINDEN AVE STE 108-B
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4990
Mailing Address - Country:US
Mailing Address - Phone:562-275-8966
Mailing Address - Fax:562-735-4141
Practice Address - Street 1:121 LINDEN AVE STE 108-B
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4990
Practice Address - Country:US
Practice Address - Phone:562-275-8966
Practice Address - Fax:562-735-4141
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical