Basic Information
| Provider Information | |||||||||
| NPI: | 1255794046 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RIVERSIDE COUNTY MENTAL HEALTH DEPARTMENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1330 W RAMSEY ST | ||||||||
| Address2: | |||||||||
| City: | BANNING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9518497142 | ||||||||
| FaxNumber: | 9518491762 | ||||||||
| Practice Location | |||||||||
| Address1: | 1330 W RAMSEY ST | ||||||||
| Address2: | |||||||||
| City: | BANNING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9518497142 | ||||||||
| FaxNumber: | 9518491762 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2016 | ||||||||
| LastUpdateDate: | 03/30/2016 | ||||||||
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| AuthorizedOfficialLastName: | ROTH-FELTER | ||||||||
| AuthorizedOfficialFirstName: | CYNTHIA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MENTAL HEALTH SERVICES SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 9518497142 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.