Provider Demographics
NPI:1932433554
Name:LONG BEACH CHILD AND ADOLESCENT PROGRAM
Entity Type:Organization
Organization Name:LONG BEACH CHILD AND ADOLESCENT PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERN
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:562-208-0969
Mailing Address - Street 1:240 E 20TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-5412
Mailing Address - Country:US
Mailing Address - Phone:562-599-9271
Mailing Address - Fax:
Practice Address - Street 1:240 E 20TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-5412
Practice Address - Country:US
Practice Address - Phone:562-599-9271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health