Provider Demographics
NPI:1649651555
Name:ZERYIHUN, KALKIDAN (LCSW)
Entity type:Individual
Prefix:
First Name:KALKIDAN
Middle Name:
Last Name:ZERYIHUN
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 1:5250 HAYTER AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-2332
Mailing Address - Country:US
Mailing Address - Phone:805-870-5709
Mailing Address - Fax:
Practice Address - Street 1:5250 HAYTER AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2332
Practice Address - Country:US
Practice Address - Phone:805-870-5709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW890351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical