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General NPI Number Information
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NPI Number | 1295179356
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Entity Type | Organization
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Legal Business Name | THE FAMILY DEPOT PSYCHOLOGICAL SERVICES, INC.
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Dates
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Enumeration Date | 04/19/2013
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Last Update Date | 04/19/2013
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Provider Practice Location Address
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Address Line | 20833 SEINE AVE
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City | LAKEWOOD
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State | CA
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Zip | 90715-1440
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Country | US
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Telephone | 562-537-5580
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Fax | 323-585-5928
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Provider Business Mailing Address
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Address Line | 20833 SEINE AVE
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City | LAKEWOOD
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State | CA
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Zip | 90715-1440
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Country | US
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Telephone | 562-537-5580
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Fax | 323-585-5928
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Authorized Official
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Title or Position | CEO
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Name | DR. ROSA M ZAPATA
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Credential | PSY.D.
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Telephone | 562-537-5580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | PSY17410
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License Number State | CA
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