Organization
ADVANCED PEDIATRIC BEHAVIORAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA MARIE RUSSO BCBA (CLINICAL DIRECTOR)
(818) 646-9229
Entity
Organization
Contact information
Practice address
10442 YOLANDA AVE, PORTER RANCH, CA 91326-3440
(818) 606-3754
Mailing address
10442 YOLANDA AVE, PORTER RANCH, CA 91326-3440
(818) 646-9229
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QH0100X
Health Service Clinic/Center
—
—
Other
Enumeration date
09/05/2019
Last updated
01/17/2024
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