Provider Demographics
NPI:1053701169
Name:MISSRY, JOANNA (MCSW,CDP,MSW,MHP)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:MISSRY
Suffix:
Gender:F
Credentials:MCSW,CDP,MSW,MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9465 WILSHIRE BLVD # 300
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-2612
Mailing Address - Country:US
Mailing Address - Phone:323-696-1826
Mailing Address - Fax:
Practice Address - Street 1:9465 WILSHIRE BLVD # 300
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2612
Practice Address - Country:US
Practice Address - Phone:323-696-1826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACDP 0271113101YA0400X
CADDMHP, CDP 027113101YM0800X
CACDP 0271113 -MHP101YP2500X, 1041C0700X
NY101YS0200X, 106H00000X
1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist