Provider Demographics
NPI:1811651797
Name:DYNAMIC PSYCHOTHERAPY CENTER INC
Entity type:Organization
Organization Name:DYNAMIC PSYCHOTHERAPY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KROCAK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:562-584-7715
Mailing Address - Street 1:24520 HAWTHORNE BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6843
Mailing Address - Country:US
Mailing Address - Phone:562-584-7715
Mailing Address - Fax:
Practice Address - Street 1:24520 HAWTHORNE BLVD STE 208
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6843
Practice Address - Country:US
Practice Address - Phone:562-584-7715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty