Provider Demographics
NPI:1295179356
Name:THE FAMILY DEPOT PSYCHOLOGICAL SERVICES, INC.
Entity Type:Organization
Organization Name:THE FAMILY DEPOT PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZAPATA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:562-537-5580
Mailing Address - Street 1:20833 SEINE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90715-1440
Mailing Address - Country:US
Mailing Address - Phone:562-537-5580
Mailing Address - Fax:323-585-5928
Practice Address - Street 1:20833 SEINE AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90715-1440
Practice Address - Country:US
Practice Address - Phone:562-537-5580
Practice Address - Fax:323-585-5928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17410251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health