Organization
BLOCKDARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STELLA M ABRAHAN PHD,MFT (SUPERVISOR)
(626) 429-3651
Entity
Organization
Contact information
Practice address
2260 BRENTFORD RD, SAN MARINO, CA 91108-2801
(626) 429-3651
Mailing address
2260 BRENTFORD RD, SAN MARINO, CA 91108-2801
(626) 429-3651
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
0M15046
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M015046
NONE
CA
Enumeration date
06/29/2014
Last updated
06/29/2014
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