Provider Demographics
NPI:1780838235
Name:SAN FERNANDO VALLEY COMMUNITY MENTAL HEALTH CENTER - FSP
Entity Type:Organization
Organization Name:SAN FERNANDO VALLEY COMMUNITY MENTAL HEALTH CENTER - FSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FSP PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALSAVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:818-785-0103
Mailing Address - Street 1:14658 OXNARD ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-3119
Mailing Address - Country:US
Mailing Address - Phone:818-785-0103
Mailing Address - Fax:818-785-0145
Practice Address - Street 1:14658 OXNARD ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-3119
Practice Address - Country:US
Practice Address - Phone:818-785-0103
Practice Address - Fax:818-785-0145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 23834251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health