Organization
STONE RIDGE ACADEMY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VIVIAN DAVID-NICOLAS PSYD (CLINICAL DIRECTOR)
(650) 863-4487
Entity
Organization
Contact information
Practice address
1115 E PUENTE ST, COVINA, CA 91724-3261
(626) 331-5900
Mailing address
1115 E PUENTE ST, COVINA, CA 91724-3261
(626) 331-5900
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
252Y00000X
Early Intervention Provider Agency
—
—
Other
Enumeration date
02/07/2015
Last updated
02/07/2015
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