Provider Demographics
NPI:1215234281
Name:BIENENFELD, JOSHUA DAVID (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:DAVID
Last Name:BIENENFELD
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10153 1/2 RIVERSIDE DR UNIT 198
Mailing Address - Street 2:
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2561
Mailing Address - Country:US
Mailing Address - Phone:818-487-2593
Mailing Address - Fax:
Practice Address - Street 1:3660 WILSHIRE BLVD STE 518
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2768
Practice Address - Country:US
Practice Address - Phone:818-404-0054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-27
Last Update Date:2020-04-05
Deactivation Date:2013-06-05
Deactivation Code:
Reactivation Date:2020-04-01
Provider Licenses
StateLicense IDTaxonomies
CALCS159821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical