| Socal Therapy Center, Inc. | |
|
19720 Ventura Blvd Ste C Woodland Hills CA 91364-2676 | |
| (818) 804-0322 | |
| Not Available |
| Full Name | Socal Therapy Center, Inc. |
|---|---|
| Speciality | Social Worker |
| Location | 19720 Ventura Blvd Ste C, Woodland Hills, California |
| Authorized Official Name and Position | Beth Jakubanis (PRESIDENT) |
| Authorized Official Contact | 8188040322 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Socal Therapy Center, Inc. 19720 Ventura Blvd Ste C Woodland Hills CA 91364-2676 Ph: (818) 804-0322 | Socal Therapy Center, Inc. 19720 Ventura Blvd Ste C Woodland Hills CA 91364-2676 Ph: (818) 804-0322 |
| NPI Number | 1871956656 |
|---|---|
| Provider Enumeration Date | 03/30/2016 |
| Last Update Date | 03/30/2016 |
| Medicare PECOS PAC ID | 6507123148 |
|---|---|
| Medicare Enrollment ID | O20171206002341 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871956656 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | LCS 28234 (California) | Primary |
| Provider Name | Darya Potyagova |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770052698 PECOS PAC ID: 1658618186 Enrollment ID: I20190122003351 |
| Provider Name | Beth Jakubanis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700079191 PECOS PAC ID: 1951668599 Enrollment ID: I20200728002252 |
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