=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063972263
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PENINSULA CENTER FOR CHILDREN AND FAMILIES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2019
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 655 DEEP VALLEY DR STE 220
-----------------------------------------------------
City | ROLLING HILLS ESTATES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90274-3661
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-936-1324
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 655 DEEP VALLEY DR STE 220
-----------------------------------------------------
City | ROLLING HILLS ESTATES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90274-3661
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-936-1324
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. JULIE PAYNE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-936-1324
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------