Provider Demographics
NPI:1760966121
Name:VILLAGE THERAPY LICENSED CLINICAL SOCIAL WORKER, PC
Entity Type:Organization
Organization Name:VILLAGE THERAPY LICENSED CLINICAL SOCIAL WORKER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANK-MELTZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-608-1457
Mailing Address - Street 1:261 S PLYMOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-3813
Mailing Address - Country:US
Mailing Address - Phone:917-608-1457
Mailing Address - Fax:
Practice Address - Street 1:444 N LARCHMONT BLVD STE 109
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3030
Practice Address - Country:US
Practice Address - Phone:323-391-8550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty