Provider Demographics
NPI:1417238833
Name:WOMEN IN TRANSITION RE-ENTRY PROJECT INC
Entity Type:Organization
Organization Name:WOMEN IN TRANSITION RE-ENTRY PROJECT INC
Other - Org Name:WOMEN IN TRANSITION RE-ENTRY PROJECT INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:REGINALD
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:PSS, BCD, MSW, LCSW
Authorized Official - Phone:310-626-7649
Mailing Address - Street 1:11138 DEL AMO BLVD STE 399
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90715-1103
Mailing Address - Country:US
Mailing Address - Phone:562-388-4688
Mailing Address - Fax:
Practice Address - Street 1:1401 E 4TH ST STE B
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-1869
Practice Address - Country:US
Practice Address - Phone:562-207-5564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-30
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMPSS-JGDBCAOtherCERTIFIED MEDI-CAL PEER SUPPORT SPECIALIST (PSS)