Provider Demographics
NPI:1235280751
Name:A CENTER FOR SELF & RELATIONSHIP DEVELOPMENT, INC.
Entity Type:Organization
Organization Name:A CENTER FOR SELF & RELATIONSHIP DEVELOPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENIA
Authorized Official - Middle Name:LIBERMAN
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LCSW
Authorized Official - Phone:949-218-8800
Mailing Address - Street 1:16052 BEACH BLVD
Mailing Address - Street 2:SUITE #214
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3801
Mailing Address - Country:US
Mailing Address - Phone:949-218-8800
Mailing Address - Fax:775-871-9678
Practice Address - Street 1:16052 BEACH BLVD
Practice Address - Street 2:SUITE #214
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3801
Practice Address - Country:US
Practice Address - Phone:949-218-8800
Practice Address - Fax:775-871-9678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21231103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty