Provider Demographics
NPI:1992189161
Name:CENTER FOR THE DEVELOPING MIND
Entity Type:Organization
Organization Name:CENTER FOR THE DEVELOPING MIND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:B
Authorized Official - Last Name:HESS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:323-428-4639
Mailing Address - Street 1:2990 S SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-0002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2990 S SEPULVEDA BLVD
Practice Address - Street 2:SUITE 308
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-0002
Practice Address - Country:US
Practice Address - Phone:323-428-4639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY#16090103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty