Healthcare Provider Details

I. General information

NPI: 1790081966
Provider Name (Legal Business Name): PDAP OF VENTURA COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2011
Last Update Date: 02/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12039 HERTZ STREET
MOORPARK CA
93021
US

IV. Provider business mailing address

450 ROSEWOOD AVE
CAMARILLO CA
93010-5914
US

V. Phone/Fax

Practice location:
  • Phone: 805-482-1265
  • Fax: 805-389-5295
Mailing address:
  • Phone: 805-485-1265
  • Fax: 805-389-5295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number560015BN
License Number StateCA

VIII. Authorized Official

Name: VIRGINIA M. CONNELL
Title or Position: EXECUTIVE DIRECTOR
Credential: LMFT
Phone: 805-482-1265