Healthcare Provider Details

I. General information

NPI: 1063972263
Provider Name (Legal Business Name): PENINSULA CENTER FOR CHILDREN AND FAMILIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 DEEP VALLEY DR STE 220
ROLLING HILLS ESTATES CA
90274-3661
US

IV. Provider business mailing address

655 DEEP VALLEY DR STE 220
ROLLING HILLS ESTATES CA
90274-3661
US

V. Phone/Fax

Practice location:
  • Phone: 310-936-1324
  • Fax:
Mailing address:
  • Phone: 310-936-1324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. JULIE PAYNE
Title or Position: CEO
Credential:
Phone: 310-936-1324