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General NPI Number Information
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NPI Number | 1336913615
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Entity Type | Organization
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Legal Business Name | LACUNA HEALING THERAPY PC
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Dates
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Enumeration Date | 11/08/2023
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Last Update Date | 11/08/2023
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Provider Practice Location Address
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Address Line | 3375 MONTAGNE WAY
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City | THOUSAND OAKS
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State | CA
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Zip | 91362
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Country | US
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Telephone | 310-924-1208
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Fax |
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Provider Business Mailing Address
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Address Line | 432 E IDAHO ST # 203
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City | KALISPELL
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State | MT
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Zip | 59901-4137
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Country | US
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Telephone | 310-924-1208
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Fax |
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Authorized Official
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Title or Position | CEO/FOUNDER
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Name | SAMANTHA ROMERO
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Credential | LCSW
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Telephone | 310-924-1208
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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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