Provider Demographics
NPI: | 1922270743 |
---|---|
Name: | HATHAWAY SYCAMORES CHILD AND FAMILY SVCS |
Entity Type: | Organization |
Organization Name: | HATHAWAY SYCAMORES CHILD AND FAMILY SVCS |
Other - Org Name: | SYCAMORES |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT AND CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | DEBBIE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MANNERS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LCSW |
Authorized Official - Phone: | 626-395-7100 |
Mailing Address - Street 1: | 840 N AVENUE 66 |
Mailing Address - Street 2: | |
Mailing Address - City: | LOS ANGELES |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 90042-1508 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 626-395-7100 |
Mailing Address - Fax: | 626-395-7100 |
Practice Address - Street 1: | 44738 SIERRA HWY |
Practice Address - Street 2: | |
Practice Address - City: | LANCASTER |
Practice Address - State: | CA |
Practice Address - Zip Code: | 93534 |
Practice Address - Country: | US |
Practice Address - Phone: | 626-395-7100 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-04-01 |
Last Update Date: | 2023-03-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 225400000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | Group - Multi-Specialty | |
No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
No | 163WP0808X | Nursing Service Providers | Registered Nurse | Psychiatric/Mental Health | Group - Multi-Specialty |
No | 164X00000X | Nursing Service Providers | Licensed Vocational Nurse | Group - Multi-Specialty | |
No | 167G00000X | Nursing Service Providers | Licensed Psychiatric Technician | Group - Multi-Specialty | |
No | 172V00000X | Other Service Providers | Community Health Worker | Group - Multi-Specialty | |
No | 174400000X | Other Service Providers | Specialist | Group - Multi-Specialty | |
No | 175T00000X | Other Service Providers | Peer Specialist | Group - Multi-Specialty | |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty | |
No | 374700000X | Nursing Service Related Providers | Technician | Group - Multi-Specialty |