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General NPI Number Information
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NPI Number | 1255139168
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Entity Type | Organization
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Legal Business Name | SOUTHERN CALIFORNIA INSTITUTE OF PSYCHOLOGY, INC.
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Dates
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Enumeration Date | 03/05/2025
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Last Update Date | 04/12/2025
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Provider Practice Location Address
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Address Line | 5050 PALO VERDE ST STE 128
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City | MONTCLAIR
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State | CA
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Zip | 91763-2334
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Country | US
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Telephone | 323-940-7749
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Fax | 323-389-9094
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Provider Business Mailing Address
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Address Line | 2058 N MILLS AVE # 112
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City | CLAREMONT
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State | CA
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Zip | 91711-2812
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Country | US
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Telephone | 323-207-9012
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHELLE S ENRIQUEZ
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Credential | LCSW
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Telephone | 323-207-9012
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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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