Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 63765 | CA |
NPI | 1003067620 |
---|---|
Provider Name | Samantha Louise Lyttle Halverson |
First Address | Torrance, CA 90501-3100 |
Second Address | Torrance, CA 90501-3100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2008 |
Last Update Date | 30/01/2019 |