Provider Demographics
NPI:1578863619
Name:COMMUNITY YOUTH CENTER
Entity Type:Organization
Organization Name:COMMUNITY YOUTH CENTER
Other - Org Name:CYC
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:L
Authorized Official - Last Name:WOO
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:415-775-2636
Mailing Address - Street 1:1038 POST ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-5603
Mailing Address - Country:US
Mailing Address - Phone:415-775-2636
Mailing Address - Fax:415-775-1345
Practice Address - Street 1:1038 POST ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5603
Practice Address - Country:US
Practice Address - Phone:415-775-2636
Practice Address - Fax:415-775-1345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health