Provider Demographics
NPI:1033617048
Name:SAN FERNANDO VALLEY TREATMENT CTR.-ANXIETY DISORDERS
Entity Type:Organization
Organization Name:SAN FERNANDO VALLEY TREATMENT CTR.-ANXIETY DISORDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:CABE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, PHP, PHD
Authorized Official - Phone:818-789-0529
Mailing Address - Street 1:13701 RIVERSIDE DR. #508,
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423
Mailing Address - Country:US
Mailing Address - Phone:818-789-0529
Mailing Address - Fax:818-789-0528
Practice Address - Street 1:13701 RIVERSIDE DR. #508
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423
Practice Address - Country:US
Practice Address - Phone:818-789-0529
Practice Address - Fax:818-789-0528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL8196104100000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty