=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861542375
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CATHOLIC CHARITIES PSYCHOLOGICAL SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1215 S HAMILTON BLVD
-----------------------------------------------------
City | POMONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91766-2850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-622-2824
-----------------------------------------------------
Fax | 909-622-6984
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1215 S HAMILTON BLVD
-----------------------------------------------------
City | POMONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91766-2850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-622-2824
-----------------------------------------------------
Fax | 909-622-6984
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR
-----------------------------------------------------
Name | SR. ROSEANITA MARY RAMIREZ
-----------------------------------------------------
Credential | L.M.F.T.
-----------------------------------------------------
Telephone | 909-622-2824
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 34250
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------