Healthcare Provider Details

I. General information

NPI: 1558691014
Provider Name (Legal Business Name): MCRORY PEDIATRIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17609 VENTURA BLVD STE 215
ENCINO CA
91316-5126
US

IV. Provider business mailing address

17609 VENTURA BLVD STE 215
ENCINO CA
91316-5126
US

V. Phone/Fax

Practice location:
  • Phone: 818-501-8352
  • Fax: 818-501-8325
Mailing address:
  • Phone: 818-501-8352
  • Fax: 818-501-8325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: MICHAEL MCRORY
Title or Position: CEO
Credential: M.B.A.
Phone: 818-501-8352