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General NPI Number Information
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NPI Number | 1770975914
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Entity Type | Organization
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Legal Business Name | SO. CAL. CHILD THERAPY
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Dates
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Enumeration Date | 02/25/2015
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Last Update Date | 02/25/2015
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Provider Practice Location Address
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Address Line | 6320 CANOGA AVE 15TH FLOOR
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City | WOODLAND HILLS
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State | CA
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Zip | 91367-2526
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Country | US
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Telephone | 818-804-0322
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Fax |
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Provider Business Mailing Address
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Address Line | 6320 CANOGA AVE 15TH FLOOR
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City | WOODLAND HILLS
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State | CA
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Zip | 91367-2526
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Country | US
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Telephone | 818-804-0322
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MS. BETH JAKUBANIS
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Credential | LCSW
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Telephone | 818-804-0322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | LCS 28234
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS 28234
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License Number State | CA
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