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Organization
SO. CAL. CHILD THERAPY
Active
Organization
SO. CAL. CHILD THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BETH JAKUBANIS LCSW (CLINICAL DIRECTOR)
(818) 804-0322
Entity
Organization
Contact information
Practice address
6320 CANOGA AVE, 15TH FLOOR, WOODLAND HILLS, CA 91367-2526
(818) 804-0322
Mailing address
6320 CANOGA AVE, 15TH FLOOR, WOODLAND HILLS, CA 91367-2526
(818) 804-0322
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCS 28234
CA
1041S0200X
School Social Worker
LCS 28234
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1700079191
INDIVIDUAL NPI NUMBER
—
Enumeration date
02/25/2015
Last updated
02/25/2015
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