Basic Information
| Provider Information | |||||||||
| NPI: | 1184783441 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LE | ||||||||
| FirstName: | BICH-LOAN | ||||||||
| MiddleName: | THI | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1975 LONG BEACH BLVD | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908065501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5622184034 | ||||||||
| FaxNumber: | 5622180402 | ||||||||
| Practice Location | |||||||||
| Address1: | 1975 LONG BEACH BLVD | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5622184034 | ||||||||
| FaxNumber: | 5622180402 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCS23400 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.