Healthcare Provider Details

I. General information

NPI: 1033617048
Provider Name (Legal Business Name): SAN FERNANDO VALLEY TREATMENT CTR.-ANXIETY DISORDERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13701 RIVERSIDE DR. #508
SHERMAN OAKS CA
91423
US

IV. Provider business mailing address

13701 RIVERSIDE DR. #508,
SHERMAN OAKS CA
91423
US

V. Phone/Fax

Practice location:
  • Phone: 818-789-0529
  • Fax: 818-789-0528
Mailing address:
  • Phone: 818-789-0529
  • Fax: 818-789-0528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberL8196
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. DENNIS D. CABE
Title or Position: PRESIDENT
Credential: MSW, PHP, PHD
Phone: 818-789-0529