Provider Demographics
NPI:1023650801
Name:HOBDY, HENRY N (PEER SPECIALIST)
Entity type:Individual
Prefix:MR
First Name:HENRY
Middle Name:N
Last Name:HOBDY
Suffix:
Gender:M
Credentials:PEER SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1873 W 54TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90062-2604
Mailing Address - Country:US
Mailing Address - Phone:323-331-5678
Mailing Address - Fax:310-349-3660
Practice Address - Street 1:1873 W 54TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90062-2604
Practice Address - Country:US
Practice Address - Phone:323-331-5678
Practice Address - Fax:310-349-3660
Is Sole Proprietor?:No
Enumeration Date:2019-10-12
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA101YM0800X, 225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA812735555Medicaid