Healthcare Provider Details

I. General information

NPI: 1437707833
Provider Name (Legal Business Name): D'VEAL FAMILY AND YOUTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 N DAISY AVE
PASADENA CA
91107-3704
US

IV. Provider business mailing address

2750 E WASHINGTON BLVD STE 230
PASADENA CA
91107-1449
US

V. Phone/Fax

Practice location:
  • Phone: 626-296-8900
  • Fax:
Mailing address:
  • Phone: 626-296-8900
  • Fax: 626-296-8911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. KIM BLACKMON
Title or Position: IBHIS DIRECTOR
Credential:
Phone: 626-296-8900