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NPI Code Detail

MEDICARE: UNIQUELY BEHAVIORAL HEALTH LLC

MEDICARE: UNIQUELY BEHAVIORAL HEALTH LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1252Y00000XEarly Intervention Provider Agency

General Provider Information

NPI Number : 1033899497
Entity Type Code : Organization
Provider Name (Legal Business Name) : UNIQUELY BEHAVIORAL HEALTH LLC
Provider Business Mailing Address
First Line : 8605 SANTA MONICA BLVD # 264936
Second Line :
City : WEST HOLLYWOOD
State : CA
Zip : 90069-4109
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 529 W 105TH ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90044-4423
Country : US
Telephone Number : 310-299-5982
Fax Number :
Authorized Official
Title or Position : FOUNDER / DIRECTOR OF OPERATIONS
Name : CAROLYN FORNEAS
Credential :
Telephone Number : 310-740-5236
Provider Enumeration Date : 07/20/2023
Last Update Date : 09/01/2023

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Directions to “UNIQUELY BEHAVIORAL HEALTH LLC ” Practice Location

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