Provider Demographics
NPI:1952624850
Name:BURG, ORLY EDELIST (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ORLY
Middle Name:EDELIST
Last Name:BURG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:ORLY
Other - Middle Name:
Other - Last Name:EDELIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3580 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2501
Mailing Address - Country:US
Mailing Address - Phone:323-937-5900
Mailing Address - Fax:
Practice Address - Street 1:3580 WILSHIRE BLVD STE 700
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2510
Practice Address - Country:US
Practice Address - Phone:323-932-0316
Practice Address - Fax:323-935-5161
Is Sole Proprietor?:No
Enumeration Date:2010-03-05
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 138711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical