Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1041C0700X | Clinical Social Worker | ||
Y | 1041C0700X | Clinical Social Worker | 68694 | CA |
NPI | 1003167404 |
---|---|
Provider Name | Valerie Ledith Bagnol |
First Address | Los Angeles, CA 90070-0024 |
Second Address | Los Angeles, CA 90031-2803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2012 |
Last Update Date | 07/06/2021 |