| Wombat Mental Health Services A Lcsw Professional Corporation | |
|
9431 Haven Avenue Suite 100 Rancho Cucamonga CA 91730-5878 | |
| (840) 999-1767 | |
| Not Available |
| Full Name | Wombat Mental Health Services A Lcsw Professional Corporation |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 9431 Haven Avenue, Rancho Cucamonga, California |
| Authorized Official Name and Position | Erik James Escareno (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 8409991767 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wombat Mental Health Services A Lcsw Professional Corporation 9431 Haven Avenue Suite 100 Rancho Cucamonga CA 91730-5878 Ph: (840) 999-1767 | Wombat Mental Health Services A Lcsw Professional Corporation 9431 Haven Avenue Suite 100 Rancho Cucamonga CA 91730-5878 Ph: (840) 999-1767 |
| NPI Number | 1285356337 |
|---|---|
| Provider Enumeration Date | 09/15/2022 |
| Last Update Date | 10/03/2022 |
| Certification Date | 10/03/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285356337 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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