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General NPI Number Information
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NPI Number | 1376913400
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Entity Type | Organization
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Legal Business Name | THE CAMDEN CENTER OLDER ADULTS PROGRAM, INC.
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Dates
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Enumeration Date | 10/01/2015
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Last Update Date | 10/01/2015
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Provider Practice Location Address
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Address Line | 10780 SANTA MONICA BLVD STE 105
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City | LOS ANGELES
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State | CA
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Zip | 90025-7613
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Country | US
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Telephone | 844-422-6336
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Fax | 888-887-2955
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Provider Business Mailing Address
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Address Line | 10780 SANTA MONICA BLVD STE 105
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City | LOS ANGELES
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State | CA
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Zip | 90025-7613
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Country | US
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Telephone | 844-422-6336
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Fax | 888-887-2955
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MISS JESSICA KLEIN
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Credential |
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Telephone | 844-422-6336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0700X
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Taxonomy Name | Adult Development & Aging Psychologist
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License Number | PSB4021549
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A112538
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | 39712
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License Number State | CA
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