Provider Demographics
NPI:1750974069
Name:CARLOS PAUL DUARTE, LICENSED CLINICAL SOCIAL WORKER CORP.
Entity type:Organization
Organization Name:CARLOS PAUL DUARTE, LICENSED CLINICAL SOCIAL WORKER CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:DUARTE
Authorized Official - Suffix:II
Authorized Official - Credentials:LCSW
Authorized Official - Phone:818-839-2232
Mailing Address - Street 1:3108 GLENDALE BLVD STE 603
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-1806
Mailing Address - Country:US
Mailing Address - Phone:818-839-2232
Mailing Address - Fax:
Practice Address - Street 1:655 N CENTRAL AVE STE 1704
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1422
Practice Address - Country:US
Practice Address - Phone:818-839-2232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-17
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health