Provider Demographics
NPI:1912235037
Name:SOOH, MAURELLA
Entity Type:Individual
Prefix:
First Name:MAURELLA
Middle Name:
Last Name:SOOH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1328 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1122
Mailing Address - Country:US
Mailing Address - Phone:310-394-6889
Mailing Address - Fax:310-394-6883
Practice Address - Street 1:1328 2ND ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1122
Practice Address - Country:US
Practice Address - Phone:310-394-6889
Practice Address - Fax:310-394-6883
Is Sole Proprietor?:No
Enumeration Date:2009-12-01
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW246581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical