| Codi Benologa Licensed Clinical Social Worker Inc | |
|
4195 N Viking Way Ste 333 Long Beach CA 90808-1466 | |
| (562) 568-9005 | |
| Not Available |
| Full Name | Codi Benologa Licensed Clinical Social Worker Inc |
|---|---|
| Speciality | Clinic/center |
| Location | 4195 N Viking Way Ste 333, Long Beach, California |
| Authorized Official Name and Position | Codi Jo Benologa (OWNER/DIRECTOR) |
| Authorized Official Contact | 4802214972 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Codi Benologa Licensed Clinical Social Worker Inc 4195 N Viking Way Ste 333 Long Beach CA 90808-1466 Ph: (562) 568-9005 | Codi Benologa Licensed Clinical Social Worker Inc 4195 N Viking Way Ste 333 Long Beach CA 90808-1466 Ph: (562) 568-9005 |
| NPI Number | 1578148805 |
|---|---|
| Provider Enumeration Date | 03/18/2021 |
| Last Update Date | 03/18/2021 |
| Certification Date | 03/18/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578148805 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (NU) | Primary |
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