Provider Demographics
NPI:1568641520
Name:PEDIATRIC PLAY THERAPY
Entity Type:Organization
Organization Name:PEDIATRIC PLAY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:408-573-7720
Mailing Address - Street 1:911 BERN CT
Mailing Address - Street 2:STE 140
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-1242
Mailing Address - Country:US
Mailing Address - Phone:408-573-7720
Mailing Address - Fax:844-789-4011
Practice Address - Street 1:911 BERN CT
Practice Address - Street 2:STE 140
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-1242
Practice Address - Country:US
Practice Address - Phone:408-573-7720
Practice Address - Fax:844-789-4011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2269261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center