Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1041C0700X | Clinical Social Worker | LCS-26448 | CA |
Y | 1041C0700X | Clinical Social Worker | LCS26448 | CA |
N | 225400000X | Rehabilitation Practitioner |
NPI | 1023149325 |
---|---|
Provider Name | Mr. Charles J Padow |
First Address | Los Angeles, CA 90095-1556 |
Second Address | Los Angeles, CA 90095-1556 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 16/08/2021 |