Provider Demographics
NPI:1528142015
Name:WERNER, MANDANA IGHANI (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MANDANA
Middle Name:IGHANI
Last Name:WERNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MANDANA
Other - Middle Name:
Other - Last Name:IGHANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4819 WIGGIN ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91377-4848
Mailing Address - Country:US
Mailing Address - Phone:805-279-5919
Mailing Address - Fax:
Practice Address - Street 1:19231 VICTORY BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-6308
Practice Address - Country:US
Practice Address - Phone:818-708-4500
Practice Address - Fax:818-654-1956
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS23253104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker