Provider Demographics
NPI:1396531919
Name:THERAPY ROOM, ISAI SERRANO, LICENSED CLINICAL SOCIAL WORKER, PROFESSIO
Entity type:Organization
Organization Name:THERAPY ROOM, ISAI SERRANO, LICENSED CLINICAL SOCIAL WORKER, PROFESSIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ISAI
Authorized Official - Middle Name:
Authorized Official - Last Name:SERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:760-391-7108
Mailing Address - Street 1:927 S BRUCE ST APT 8
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-1113
Mailing Address - Country:US
Mailing Address - Phone:657-791-6082
Mailing Address - Fax:
Practice Address - Street 1:79505 CAMELBACK DR
Practice Address - Street 2:
Practice Address - City:BERMUDA DUNES
Practice Address - State:CA
Practice Address - Zip Code:92203-1485
Practice Address - Country:US
Practice Address - Phone:657-791-6082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty