Provider Demographics
NPI:1841550589
Name:MISHAEL, NADIA (PSYD, LCSW)
Entity type:Individual
Prefix:DR
First Name:NADIA
Middle Name:
Last Name:MISHAEL
Suffix:
Gender:F
Credentials:PSYD, LCSW
Other - Prefix:DR
Other - First Name:NADIA
Other - Middle Name:
Other - Last Name:MISHAEL-SWEENEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD, LCSW
Mailing Address - Street 1:1800 FAIRBURN AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5958
Mailing Address - Country:US
Mailing Address - Phone:310-470-6444
Mailing Address - Fax:310-475-6296
Practice Address - Street 1:1800 FAIRBURN AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5958
Practice Address - Country:US
Practice Address - Phone:310-470-6444
Practice Address - Fax:310-475-6296
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-28
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS203581041C0700X
CAPSY25514103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical