Provider Demographics
NPI:1083345599
Name:ALONGSIDE PSYCHOLOGICAL SERVICES INC.
Entity Type:Organization
Organization Name:ALONGSIDE PSYCHOLOGICAL SERVICES INC.
Other - Org Name:CARROLL-WRAY PSYCHOLOGICAL SERVICES INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROLL-WRAY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-732-2717
Mailing Address - Street 1:1514 17TH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-3443
Mailing Address - Country:US
Mailing Address - Phone:323-306-0736
Mailing Address - Fax:
Practice Address - Street 1:1514 17TH ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-3442
Practice Address - Country:US
Practice Address - Phone:847-732-2717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-23
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1124631312OtherNPI