MEDICARE: HATHAWAY SYCAMORES CHILD AND FAMILY SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103TC0700X	Clinical Psychologist
2	1041C0700X	Clinical Social Worker
3	106H00000X	Marriage & Family Therapist
4	163WP0808X	Psychiatric/Mental Health Registered Nurse
5	164X00000X	Licensed Vocational Nurse
6	167G00000X	Licensed Psychiatric Technician
7	172V00000X	Community Health Worker
8	174400000X	Specialist
9	175T00000X	Peer Specialist
10	2084P0800X	Psychiatry Physician
11	208D00000X	General Practice Physician
12	225400000X	Rehabilitation Practitioner
13	374700000X	Technician
14	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1669039368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HATHAWAY SYCAMORES CHILD AND FAMILY SERVICES

Provider Business Mailing Address
First Line	:	840 N AVENUE 66
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90042-1508
Country	:	US
Telephone Number	:	626-395-7100
Fax Number	:	626-395-7270

Provider Business Practice Location Address
First Line	:	12540 PIERCE ST
Second Line	:
City	:	PACOIMA
State	:	CA
Zip	:	91331-1701
Country	:	US
Telephone Number	:	626-395-7100
Fax Number	:	626-395-7270

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	DEBBIE MANNERS
Credential	:	LCSW
Telephone Number	:	626-395-7100

Provider Enumeration Date	:	05/29/2019
Last Update Date	:	03/31/2023

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