Provider Demographics
NPI:1013297266
Name:CLAUDIA JOAN ROSA-BIENENFELD, MSW LICENSED CLINICAL SOCIAL WORKER, A P
Entity Type:Organization
Organization Name:CLAUDIA JOAN ROSA-BIENENFELD, MSW LICENSED CLINICAL SOCIAL WORKER, A P
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDIA JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSA-BIENENFELD
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:818-487-2593
Mailing Address - Street 1:10153 1/2 RIVERSIDE DRIVE, SUITE 198
Mailing Address - Street 2:
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2561
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:818-487-8591
Practice Address - Street 1:11911 SAN VICENTE BLVD
Practice Address - Street 2:SUITE 280
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-5086
Practice Address - Country:US
Practice Address - Phone:818-487-2593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-19
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS19209251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health