Provider Demographics
NPI:1396440822
Name:KHALIL, HEIDI (LCSW)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:
Last Name:KHALIL
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 1:4204 WOODLEIGH LN
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-3537
Mailing Address - Country:US
Mailing Address - Phone:323-240-5220
Mailing Address - Fax:
Practice Address - Street 1:4204 WOODLEIGH LN
Practice Address - Street 2:
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-3537
Practice Address - Country:US
Practice Address - Phone:323-240-5220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW204521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical