Provider Demographics
NPI:1003463258
Name:STUDIO CITY CLINICAL ASSOCIATES A LICENSED CLINICAL SOCIAL WORKER CORP
Entity Type:Organization
Organization Name:STUDIO CITY CLINICAL ASSOCIATES A LICENSED CLINICAL SOCIAL WORKER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:F
Authorized Official - Last Name:CHAMBRE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:818-425-9925
Mailing Address - Street 1:11712 MOORPARK ST STE 205B
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2158
Mailing Address - Country:US
Mailing Address - Phone:818-425-9982
Mailing Address - Fax:
Practice Address - Street 1:11712 MOORPARK ST STE 205B
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2158
Practice Address - Country:US
Practice Address - Phone:818-425-9982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-22
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty