Provider Demographics
NPI:1235381799
Name:GAY AND LESBIAN ADOLESCENT SOCIAL SERVICES, INC
Entity Type:Organization
Organization Name:GAY AND LESBIAN ADOLESCENT SOCIAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:DECRESCENZO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:818-239-0112
Mailing Address - Street 1:1033 N HOLLYWOOD WAY
Mailing Address - Street 2:UNIT F
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-2540
Mailing Address - Country:US
Mailing Address - Phone:818-239-0112
Mailing Address - Fax:818-239-0244
Practice Address - Street 1:1672 W AVENUE J
Practice Address - Street 2:SUITE 203
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2827
Practice Address - Country:US
Practice Address - Phone:818-239-0112
Practice Address - Fax:818-239-0244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health