Provider Demographics
NPI:1659781623
Name:HATHAWAY-SYCAMORES CHILD AND FAMILY SERVICES
Entity Type:Organization
Organization Name:HATHAWAY-SYCAMORES CHILD AND FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FSP CHILD CLINICIAN II
Authorized Official - Prefix:
Authorized Official - First Name:GIOVANNA
Authorized Official - Middle Name:ANDREA
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:818-287-9130
Mailing Address - Street 1:12510 VAN NUYS BLVD
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-1338
Mailing Address - Country:US
Mailing Address - Phone:818-287-9130
Mailing Address - Fax:
Practice Address - Street 1:12510 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-1338
Practice Address - Country:US
Practice Address - Phone:818-287-9130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW 59641251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCSW59641OtherMEDI-CAL