Healthcare Provider Details

I. General information

NPI: 1477829786
Provider Name (Legal Business Name): STEP-BY-STEP EDU PLAY PROGRAMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2012
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1814 14TH ST 203
SANTA MONICA CA
90404-7028
US

IV. Provider business mailing address

1814 14TH ST STE 203
SANTA MONICA CA
90404-7006
US

V. Phone/Fax

Practice location:
  • Phone: 310-409-5463
  • Fax:
Mailing address:
  • Phone: 310-409-5463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberPSY23855
License Number StateCA

VIII. Authorized Official

Name: DR. KEARNEY N VISSER
Title or Position: DIRECTOR OF BEHAVIOR INTERVENTION
Credential: PH.D.
Phone: 310-409-5463