Provider Demographics
NPI:1033899497
Name:UNIQUELY BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:UNIQUELY BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER / DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:FORNEAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-740-5236
Mailing Address - Street 1:8605 SANTA MONICA BLVD # 264936
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-4109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:529 W 105TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-4423
Practice Address - Country:US
Practice Address - Phone:310-299-5982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-20
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency