Provider Demographics
NPI:1679085336
Name:SOCIAL COLLABORATIVE LLC
Entity Type:Organization
Organization Name:SOCIAL COLLABORATIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HSING AN
Authorized Official - Middle Name:DAISY
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:415-646-6223
Mailing Address - Street 1:2441 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90814-2205
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:333 EL CAMINO REAL STE 200
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3605
Practice Address - Country:US
Practice Address - Phone:415-646-6223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-02
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities