=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467882936
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTER FOR DEVELOPMENTAL PLAY AND LEARNING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2013
-----------------------------------------------------
Last Update Date | 08/31/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4675 VIA LOS SANTOS
-----------------------------------------------------
City | SANTA BARBARA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93111-1346
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-964-2700
-----------------------------------------------------
Fax | 805-964-2722
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4675 VIA LOS SANTOS
-----------------------------------------------------
City | SANTA BARBARA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93111-1346
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-964-2700
-----------------------------------------------------
Fax | 805-964-2722
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | PATRICIA DEINES MARQUART
-----------------------------------------------------
Credential | MFT
-----------------------------------------------------
Telephone | 805-729-2051
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFC 14111
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | MFC 36439
-----------------------------------------------------
License Number State |
-----------------------------------------------------