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General NPI Number Information
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NPI Number | 1992273338
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Entity Type | Organization
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Legal Business Name | BOSTON CHILD STUDY CENTER LOS ANGELES LICENSED CLINICAL SOCIAL WORK SE
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Dates
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Enumeration Date | 11/04/2018
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Last Update Date | 11/04/2018
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Provider Practice Location Address
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Address Line | 11400 W OLYMPIC BLVD STE 200
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City | LOS ANGELES
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State | CA
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Zip | 90064-1584
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Country | US
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Telephone | 888-225-1995
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Fax |
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Provider Business Mailing Address
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Address Line | 729 BOYLSTON ST FL 5
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City | BOSTON
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State | MA
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Zip | 02116-2639
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Country | US
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Telephone | 617-299-0228
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Fax |
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Authorized Official
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Title or Position | FOUNDER & DIRECTOR
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Name | DR. RYAN J MADIGAN
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Credential | PSY.D.
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Telephone | 617-299-0228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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