| So. Cal. Child Therapy | |
|
6320 Canoga Ave 15th Floor Woodland Hills CA 91367-2526 | |
| (818) 804-0322 | |
| Not Available |
| Full Name | So. Cal. Child Therapy |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 6320 Canoga Ave, Woodland Hills, California |
| Authorized Official Name and Position | Beth Jakubanis (CLINICAL DIRECTOR) |
| Authorized Official Contact | 8188040322 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| So. Cal. Child Therapy 6320 Canoga Ave 15th Floor Woodland Hills CA 91367-2526 Ph: (818) 804-0322 | So. Cal. Child Therapy 6320 Canoga Ave 15th Floor Woodland Hills CA 91367-2526 Ph: (818) 804-0322 |
| NPI Number | 1770975914 |
|---|---|
| Provider Enumeration Date | 02/25/2015 |
| Last Update Date | 02/25/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770975914 | NPI | - | NPPES |
| 1700079191 | Other | INDIVIDUAL NPI NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | LCS 28234 (California) | Primary |
| 1041S0200X | Social Worker - School | LCS 28234 (California) | Secondary |
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