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General NPI Number Information
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NPI Number | 1831634385
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Entity Type | Organization
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Legal Business Name | SPECIAL NEEDS RESOURCE GROUP
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Dates
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Enumeration Date | 12/19/2016
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Last Update Date | 12/19/2016
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Provider Practice Location Address
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Address Line | 2716 OCEAN PARK BLVD STE 1025
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City | SANTA MONICA
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State | CA
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Zip | 90405-5255
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Country | US
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Telephone | 310-392-0835
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Fax | 310-622-4155
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Provider Business Mailing Address
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Address Line | 2716 OCEAN PARK BLVD STE 1025
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City | SANTA MONICA
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State | CA
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Zip | 90405-5255
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Country | US
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Telephone | 310-392-0835
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Fax | 310-622-4155
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Authorized Official
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Title or Position | BCBA
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Name | YRAMNNA SMITH
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Credential | PSYD BCBA
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Telephone | 310-392-0835
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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 | 11410167
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License Number State | CA
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