Provider Demographics
NPI:1003529843
Name:INNOCENZI, NATALIE ANNE (LCSW)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:ANNE
Last Name:INNOCENZI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 NEWBY ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-2209
Mailing Address - Country:US
Mailing Address - Phone:626-818-0077
Mailing Address - Fax:
Practice Address - Street 1:1118 NEWBY ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-2209
Practice Address - Country:US
Practice Address - Phone:626-818-0077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-26
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1076261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical