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General NPI Number Information
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NPI Number | 1033617048
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Entity Type | Organization
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Legal Business Name | SAN FERNANDO VALLEY TREATMENT CTR.-ANXIETY DISORDERS
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Dates
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Enumeration Date | 01/24/2018
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Last Update Date | 01/24/2018
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Provider Practice Location Address
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Address Line | 13701 RIVERSIDE DR. #508
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City | SHERMAN OAKS
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State | CA
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Zip | 91423
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Country | US
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Telephone | 818-789-0529
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Fax | 818-789-0528
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Provider Business Mailing Address
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Address Line | 13701 RIVERSIDE DR. #508,
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City | SHERMAN OAKS
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State | CA
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Zip | 91423
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Country | US
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Telephone | 818-789-0529
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Fax | 818-789-0528
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DENNIS D. CABE
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Credential | MSW, PHP, PHD
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Telephone | 818-789-0529
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | L8196
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License Number State | CA
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