Provider Demographics
NPI:1235373838
Name:THE INFANT PARENT MENTAL HEALTH FOUNDATION
Entity Type:Organization
Organization Name:THE INFANT PARENT MENTAL HEALTH FOUNDATION
Other - Org Name:WELL BABY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GROENING
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:310-402-2229
Mailing Address - Street 1:12316 VENICE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-3802
Mailing Address - Country:US
Mailing Address - Phone:310-402-2229
Mailing Address - Fax:
Practice Address - Street 1:12316 VENICE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-3802
Practice Address - Country:US
Practice Address - Phone:310-402-2229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-27
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45236261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health