Provider Demographics
NPI:1033423538
Name:THERCARE
Entity Type:Organization
Organization Name:THERCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:SHAW
Authorized Official - Last Name:ROSENSTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MDR, PH D
Authorized Official - Phone:310-949-9267
Mailing Address - Street 1:11980 SAN VICENTE BLVD., SUITE 711
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049
Mailing Address - Country:US
Mailing Address - Phone:310-949-9267
Mailing Address - Fax:310-826-7823
Practice Address - Street 1:11980 SAN VICENTE BLVD., SUITE 711
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049
Practice Address - Country:US
Practice Address - Phone:310-949-9267
Practice Address - Fax:310-826-7823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22454103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Single Specialty