Provider Demographics
NPI:1215480694
Name:LIM, IRENE (LCSW)
Entity type:Individual
Prefix:MS
First Name:IRENE
Middle Name:
Last Name:LIM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4650 SUNSET BLVD
Mailing Address - Street 2:MAILSTOP 2
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6062
Mailing Address - Country:US
Mailing Address - Phone:323-361-3111
Mailing Address - Fax:323-913-7951
Practice Address - Street 1:3250 WILSHIRE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1439
Practice Address - Country:US
Practice Address - Phone:323-361-3111
Practice Address - Fax:323-913-7951
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS25165104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker