Healthcare Provider Details

I. General information

NPI: 1528368735
Provider Name (Legal Business Name): SOCIAL SERVICE PROFESSIONALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2010
Last Update Date: 10/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6938 LAUREL CANYON BLVD., UNIT 316
NORTH HOLLYWOOD CA
91605
US

IV. Provider business mailing address

11835 W. OLYMPIC LVD., STE. 1090
LOS ANGELES CA
90064
US

V. Phone/Fax

Practice location:
  • Phone: 310-497-3718
  • Fax:
Mailing address:
  • Phone: 310-473-4448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateCA

VIII. Authorized Official

Name: MS. MERYL STERN
Title or Position: VICE PRESIDENT
Credential:
Phone: 310-473-4448