Provider Demographics
NPI:1841924131
Name:THERAPY COLLABORATIVE A LICENSED CLINICAL SOCIAL WORKER CO
Entity type:Organization
Organization Name:THERAPY COLLABORATIVE A LICENSED CLINICAL SOCIAL WORKER CO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/EMPLOYEE
Authorized Official - Prefix:MS
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTENEGRO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:213-493-7813
Mailing Address - Street 1:PO BOX 9247
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92812-7247
Mailing Address - Country:US
Mailing Address - Phone:213-493-7813
Mailing Address - Fax:
Practice Address - Street 1:307 E 44TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-4400
Practice Address - Country:US
Practice Address - Phone:213-493-7813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-12
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)