Healthcare Provider Details

I. General information

NPI: 1154761146
Provider Name (Legal Business Name): FOR FAMILIES, PSYCHOLOGY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2013
Last Update Date: 12/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12260 VENTURA BLVD., SUITE LL30
ENCINO CA
91436
US

IV. Provider business mailing address

16260 VENTURA BLVD. SUITE LL30
ENCINO CA
91436
US

V. Phone/Fax

Practice location:
  • Phone: 818-990-5906
  • Fax: 818-990-5904
Mailing address:
  • Phone: 818-990-5906
  • Fax: 818-990-5904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY13323
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 22300
License Number StateCA

VIII. Authorized Official

Name: DR. CLARITA WISNIA
Title or Position: PRESIDENT
Credential: PH.D
Phone: 818-990-5906